Vanderbilt University Medical Center, Tennessee 37232, USA.
Curr Opin Pulm Med. 2010 Jul;16(4):351-6. doi: 10.1097/MCP.0b013e328338c486.
Dasatinib is a novel tyrosine-kinase inhibitor approved for treatment of BCR-ABL positive chronic myeloid leukemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukemia (ALL) after imatinib failure. Use of dasatinib is frequently complicated by pleural effusions. This review highlights the risk factors for development of effusions as well as characteristics of the pleural fluid. Potential mechanisms involved and a set of management recommendations based on available evidence are also discussed.
The incidence of dasatinib-associated pleural effusions is approximately 20%. A twice-daily dosing regimen was found to significantly correlate with development of effusions, and therefore once-daily dosing is now approved for treatment of chronic myeloid leukemia and acute lymphoblastic leukemia. Dasatinib-associated pleural effusions are generally lymphocyte-predominant exudates. The mechanism of occurrence is unknown but may involve an immune-mediated pathway or off-target inhibition of platelet-derived growth factor receptor, beta polypeptide. Management typically involves dose interruption or reduction, diuretics and short-term corticosteroid therapy.
Dasatinib is a promising agent for the treatment of refractory chronic myeloid leukemia and acute lymphoblastic leukemia. Its use can be complicated by development of exudative pleural effusions of unclear etiology. Incidence is decreasing with once-daily dosing, but when effusions do occur, most can be managed with specific measures without necessitating discontinuation of therapy.
达沙替尼是一种新型的酪氨酸激酶抑制剂，获批用于治疗伊马替尼治疗失败后的 BCR-ABL 阳性慢性髓性白血病（CML）和费城染色体阳性急性淋巴细胞白血病（ALL）。达沙替尼的应用常伴有胸腔积液。本综述重点介绍了胸腔积液发生的风险因素及胸腔积液的特征。还讨论了潜在的发病机制和基于现有证据的一系列管理建议。
达沙替尼相关胸腔积液的发生率约为 20%。每日两次的给药方案与胸腔积液的发生显著相关，因此目前每日一次的剂量方案已获批用于治疗慢性髓性白血病和急性淋巴细胞白血病。达沙替尼相关胸腔积液通常以淋巴细胞为主的渗出液。发生机制尚不清楚，但可能涉及免疫介导途径或血小板衍生生长因子受体β多肽的非靶点抑制。管理通常包括剂量中断或减少、利尿剂和短期皮质类固醇治疗。
达沙替尼是治疗难治性慢性髓性白血病和急性淋巴细胞白血病的一种很有前途的药物。其应用可导致渗出性胸腔积液的发生，其病因不明。每日一次的剂量方案可降低发生率，但当胸腔积液发生时，大多数情况下可通过特定措施进行管理，无需停止治疗。
