Extensive pleural and pericardial effusion in chronic myeloid leukemia during treatment with dasatinib at 100 mg or 50 mg daily

Abstract

Dasatinib is considered an effective drug in imatinib-resistant chronic myeloid leukemia. Although reported to be well-tolerated, severe events such as pleural or pericardial effusion have been reported at 140 mg daily. We examined our chronic myeloid leukemia patients treated with dasatinib at 100 mg or 50 mg daily and identified 4 of 13 patients who developed marked effusion formation. In 2 patients, grade III/IV pleural and/or pericardial effusions were recorded. All 4 patients had received previous anti-leukemia therapy but none had preexisting cardiac or pulmonary diseases. In 3 patients, dasatinib had to be discontinued despite treatment with diuretics and glucocorticosteroids. In conclusion, dasatinib-treated chronic myeloid leukemia patients are at risk for the development of pleural and pericardial effusions even when the drug is administered at 100 mg or 50 mg daily. Therefore, all patients should be examined for pre-existing comorbidity and risk factors before starting dasatinib and all should have repeated chest Xrays during long-term dasatinib therapy.

A Case of Dasatinib-Induced Hemorrhagic Colitis Diagnosed by the Lymphocyte Transformation Test in a Chronic Myeloid Leukemia Patient

“…In cases with elevated liver enzymes, those returned to normal after the dose reduction. In cases with pleural effusion or pericardial effusion, those are resolved with supportive care and diuretics treatment after the drug discontinuation [1,12]. Diarrhea, peripheral edema or headache [1] and immunosuppression-induced vulnerability to infection was also observed.…”

Pleural and pericardial effusions in chronic myeloid leukemia patients receiving low-dose dasatinib therapy

“…We read with interest the paper about pleural and pericardial effusion in chronic myeloid leukemia during lowdose dasatinib treatment by Krauth et al 1 They reported 4 patients who developed effusions with 50 or 100 mg daily dasatinib out of a total number of 13 patients. Pleural and pericardial effusions were grade III/IV in 2 of the patients.…”

Second line BCR/ABK TKI-associated severe adverse events:preferential occurrence in patients with comorbidities

“…For dasatinib-treated patients, the occurrence of pleural effusion is a clinical challenge, [8][9][10][11][12] especially when pleural effusion is recurrent or accompanied by a perciardial effusion, pulmonary hypertension, or an infection. Several other non-hematologic adverse events have also been described for dasatinib, including diarrhea, skin rash, bleeding, viral re-activation, and sometimes also opportunistic infections which have been reported in patients receiving dasatinib at a dose of 2¥70 mg daily (Table 1).…”

“…9 However, even in patients receiving 100 mg once daily, pleural effusions develop and may accumulate over time. 12,13 Nilotinib-treated patients may develop increases in pancreatic enzymes, bilirubin, and fasting glucose level (Table 1). 5,14,15 Other non-hematologic adverse events include diarrhea, a folliculitis-like skin rash, and bleeding.…”