Ascites does not accompany pleural effusion developing under dasatinib therapy in patients with CML-CP

Abstract

Objectives: Pleural effusion (PE) is the most frequent pulmonary complication of dasatinib, a tyrosine kinase inhibitor (TKI). Concurrent pericardial effusions have been reported in about one-third of the cases. In this study, we aimed to investigate ascites generation in chronic-phase chronic myeloid leukemia (CML-CP) patients developing PE under dasatinib.

Methods: We conducted a cross-sectional study to evaluate whether pericardial effusion and ascites accompany PE in CML-CP patients treated with dasatinib. For this purpose, consecutive patients with CML-CP who developed PE under dasatinib therapy have been evaluated with chest X-ray, transthoracic echocardiography, and abdominal ultrasonography.

Results: There were seven patients, and the median age was 50 years (range, 31-73 years). Most of patients were male (n=5). All patients received imatinib as first-line TKI. Six patients received dasatinib following imatinib failure in second line. The median duration from dasatinib initiation to PE generation was 58 months (range, 8-135 months). Consequently, four patients had grade 1 pericardial effusion, and no patient had ascites.

Conclusions: In our small study, dasatinib-related PE was associated with low-grade pericardial effusion but no ascites. There are hypothetical explanations of this phenomenon including the simultaneous activation/inhibition of kinases; however, more research needs to be performed on this topic.

Keywords: ascites; chronic myeloid leukemia; chronic-phase chronic myeloid leukemia (CML-CP); dasatinib; pleural effusion.

Figure 1:

The chest X-ray, transthoracic echocardiography, and abdominal ultrasonography images of Patient #4. (A) Bilateral pleural effusion in chest X-ray. (B) Minimal pericardial effusion detected in TTE (Ao, aorta; LA, left atrium; LV, left ventricle; RV, right ventricle. *Parasternal long-axis view demonstrating pericardial effusion). (C and D) AUS showing no ascites in the perihepatic area (C) and no peritoneal fluid between the bowel loops (D).