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Pharmacokinetics of dasatinib in a hemodialysis patient with chronic myeloid leukemia and chronic kidney disease


Until now, no studies have addressed the use of dasatinib in hemodialysis patients. Herein, we report the case of a 73-year-old hemodialysis patient with chronic myeloid leukemia (CML) who was treated with dasatinib. For 5 years prior, the patient had received nilotinib for the treatment of CML. Regular hemodialysis was initiated due to progression of hypertensive nephrosclerosis, whereupon nilotinib was discontinued and the patient began receiving 100 mg dose of dasatinib once daily. On dialysis days, dasatinib was administered immediately after completion of dialysis. Four months after starting dasatinib, we performed a pharmacokinetic study. The plasma concentrations of dasatinib before, immediately, and 2 h after the completion of hemodialysis were 7.4, 6.1, and 59.5 ng/mL, respectively. Ultrasound cardiography revealed a gradual decline in ejection fraction during dasatinib therapy. Because the patient’s dasatinib trough concentration was higher (6.1 ng/mL) than the target level (1.5 ng/mL), we suspected the development of dasatinib-related heart dysfunction; thus, dasatinib was discontinued 6 months after its initiation. We concluded that hemodialysis patients are potentially vulnerable to the cardiotoxic effects of dasatinib; monitoring of cardiac function and plasma drug concentration may thus be useful in assessing their condition.

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NT reports grants and personal fees obtained from Novartis Pharmaceuticals, personal fees from Bristol-Myers Squibb, grants and personal fees from Pfizer, grants and personal fees from Otsuka Pharmaceutical, grants from Kyowa Hakko Kirin, grants from Astellas Pharma, grants from Chugai Pharmaceutical, grants from Asahi Kasei Pharma, grants from Ono Pharmaceutical, and grants from Eisai Pharmaceuticals, which are all unrelated the study reported herein.

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Correspondence to Jinichi Mori.

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Mori, J., Oshima, K., Tanimoto, T. et al. Pharmacokinetics of dasatinib in a hemodialysis patient with chronic myeloid leukemia and chronic kidney disease. Int J Hematol 112, 115–117 (2020).

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  • Dasatinib
  • Hemodialysis
  • Pharmacokinetics
  • CML
  • Cardiotoxicity