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Case Reports
. 2015 Oct;47(4):937-42.
doi: 10.4143/crt.2013.155. Epub 2014 Nov 17.

Reversible Pulmonary Arterial Hypertension Associated with Dasatinib for Chronic Myeloid Leukemia

Ji Hyung Hong  1   2 , Sung-Eun Lee  2   3 , Soo Young Choi  2 , Soo-Hyun Kim  2 , Eun-Jung Jang  2 , Ju-Hee Bang  2 , Jin Eok Park  2 , Hye-Rim Jeon  2 , Yun Jeong Oh  2 , Jeong-Eun Yi  4 , Hae Ok Jung  4 , Ho Joong Youn  4 , Dong-Wook Kim  2   3
Affiliations
Case Reports

Reversible Pulmonary Arterial Hypertension Associated with Dasatinib for Chronic Myeloid Leukemia

Ji Hyung Hong et al. Cancer Res Treat. 2015 Oct.

Abstract

We describe two cases of pulmonary arterial hypertension (PAH) that occurred under dasatinib treatment and were resolved after dasatinib discontinuation. Two patients with chronic phase chronic myeloid leukemia (CML) were switched to dasatinib therapy because of hematological progress while receiving imatinib. These patients had New York Heart Association (NYHA) functional class II dyspnea with elevated right ventricular systolic pressure (RVSP), which progressed under dasatinib treatment. After dasatinib treatment was discontinued, subjective symptoms were improved to NYHA functional class I and the follow-up transthoracic Doppler echocardiography showed improved RVSP. Treatment with an alternate tyrosine kinase inhibitor was initiated and had been continued without development of dyspnea or elevation of RVSP. This report suggests that dasatinib can cause the reversible PAH, therefore, routine cardiopulmonary evaluation before and during treatment with dasatinib may be needed in CML patients with clinical manifestations.

Keywords: Chronic myeloid leukemia; Dasatinib; Pulmonary arterial hypertension.

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Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1.
Fig. 1.
(A) The changes in clinical courses, cardiopulmonary parameters and treatment history in patient in case 1 are depicted over time. (B) The changes in parameters of in patient in case 2 are depicted over time. (C) Patient in case 1 had an elevated tricuspid regurgitation velocity (4.4 m/sec), consistent with pulmonary arterial hypertension (left). Four months after dasatinib discontinuation (right), there was an improvement of tricuspid regurgitation velocity (3.6 m/sec) in patient 1. NYHA, New York Heart Association; RVSP, right ventricular systolic pressure; G, grade; SF, sildenafil; TKI, thyrosine kinase inhibitor; HUR, hydroxyurea; IM, imatinib; Das, dasatinib; Pon, ponatinib; HR, hematologic response; CP, chronic phase; CHR, complete hematologic response; IS, international scale; Nil, nilitinib.
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