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Dasatinib-induced chylothorax: report of a case and review of the literature

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Summary

Dasatinib is a tyrosine kinase inhibitor for the treatment of BCR-ABL-positive chronic myeloid leukaemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukaemia (ALL). Although fluid retention is a common adverse event associated with dasatinib, chylothorax is exceptionally rare. The pathological mechanism, clinical manifestation and management of dasatinib-induced chylothorax are completely unclear. A 71-year-old man treated with dasatinib for CML was admitted for progressive dyspnea. Computed tomography (CT) showed a pleural effusion that was more prominent on the right thoracic cavity. Thoracentesis showed thick milky pleural fluid, which was then confirmed as chylothorax by chylum qualitative tests and triglyceride measurements. Radionuclide lymphoscintigraphy yielded an obstruction at the end segment of the thoracic duct, but no leakage points were found. After excluding common causes, drug-induced chylothorax was presumed. Then, dasatinib was withdrawn, and 1 week later, chylothorax resolved. To further elucidate the relationship between the medication and chylothorax, dasatinib was resumed tentatively for 2 days. As expected, pleural effusion recurred soon. Based on these clinical manifestations, the diagnosis of dasatinib-induced chylothorax was identified. The patient was suggested to stop dasatinib and use an alternative drug as recommended by the haematologist. Pleural effusion is the common adverse reaction of dasatinib, but chylothorax is rare. Only six cases of dasatinib-induced chylothorax have been reported, and our patient is the seventh case. Once a patient with dasatinib treatment develops chylothorax, dasatinib should be considered one of the possible causes. If no other definitive aetiological factor is identified, dasatinib discontinuation might be the optimum scheme.

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Data availability

All data generated or analysed during this study are included in this published article.

Abbreviations

CML:

chronic myeloid leukaemia

ALL:

acute lymphoblastic leukaemia

FDA:

Food and Drug Administration

cCCyR:

complete cytogenetic response

MMR:

major molecular response

CMR:

complete molecular response

PDGFRβ:

platelet-derived growth factor receptor beta

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Acknowledgements

We thank the patient and his families for participating in the study with patience and cooperation.

Funding

This research was supported by the National Key R&D Program of China (2018YFC1311900), the National Natural Science Foundation of China (91859203, 81871890) and the Key Program from the Department of Science and Technology, Sichuan Province, China (2017SZ0052). These funders approved the design of the study but had no role in the collection, analysis, and interpretation of data or in writing the manuscript.

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Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Bojiang Chen, Zuohong Wu, Qin Wang, Weimin Li & Deyun Cheng

Authors
  1. Bojiang Chen
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  2. Zuohong Wu
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  3. Qin Wang
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  4. Weimin Li
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  5. Deyun Cheng
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Contributions

BC, DC and WL designed the study. BC, ZW and QW collected the patients’ data and drafted the manuscript. BC and ZW performed the literature review. DC and WL revised the manuscript. All authors read and approved the final manuscript submission.

Corresponding authors

Correspondence to Weimin Li or Deyun Cheng.

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Ethics approval and consent to participate

This study conformed to the Declaration of Helsinki and was approved by the Ethics Committee of West China Hospital, Sichuan University, China.

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Written informed consent was obtained from the patient for the publication of this report and any accompanying images.

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None.

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Chen, B., Wu, Z., Wang, Q. et al. Dasatinib-induced chylothorax: report of a case and review of the literature. Invest New Drugs 38, 1627–1632 (2020). https://doi.org/10.1007/s10637-020-00932-3

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  • DOI: https://doi.org/10.1007/s10637-020-00932-3

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