PDF(Pubmed)
Abstract：
Dasatinib is one of the second generation tyrosine kinase inhibitors (TKI) which is approved for the treatment of patients with chronic phase CML (CP-CML) both in the front line and in the second line setting. Pleural effusion (PE) is a unique toxicity associated with dasatinib use. Our aim was to study the incidence of pleural effusion in our cohort of patients who were treated with dasatinib for CP-CML and the safety upon TKI switch. A total of 390 patients were treated with dasatinib during their course of treatment for CP-CML. A total of 69 patients (17.6%) developed any grade of PE. About 33 (48%) patients developed CTCAE grade 2 PE, 34 (49%) grade 3 and only 1 patient developed grade 4 PE. Recurrence of PE was observed in 34 (49%) patients. While only 12 patients (17.3%) continued using dasatinib after development of PE, dasatinib was discontinued in the other 57 patients. Therapy was switched to bosutinib in 13 patients out of which 6 (46%) patients re-developed PE. While only 12.5% patients developed re-accumulation of pleural fluid in patients switched to imatinib, none of the patients switched to nilotinib re-developed PE. A change in TKI to bosutinib was associated with a 46% risk of recurrence of PE in patients who develop PE on dasatinib for the treatment of CP-CML. The incidence of recurrent PE was markedly lower in patient switched to imatinib or nilotinib.
摘要：
达沙替尼是第二代酪氨酸激酶抑制剂（TKI）之一，已被批准用于一线和二线治疗慢性期CML（CP-CML）患者。胸腔积液（PE）是与达沙替尼使用相关的独特毒性。我们的目的是研究使用达沙替尼治疗CP-CML的患者队列中胸腔积液的发生率以及TKI转换后的安全性。总共390名患者在CP-CML的治疗过程中接受了达沙替尼治疗。共有69名患者(17.6%)发展为任何级别的PE。约33例（48%）患者出现CTCAE2级PE，34（49％）3级，只有1名患者发展为4级PE。在34例（49％）患者中观察到PE复发。虽然只有12名患者（17.3％）在PE发展后继续使用达沙替尼，其他57例患者停用了达沙替尼.13例患者改用博舒替尼治疗，其中6例（46%）患者重新发展为PE。虽然只有12.5%的患者出现胸水再积聚，但患者改用伊马替尼，没有患者改用尼洛替尼重新发展PE。在使用达沙替尼治疗CP-CML的患者中，TKI改为博舒替尼与46％的PE复发风险相关。在改用伊马替尼或尼洛替尼的患者中，复发性PE的发生率明显降低。
