Chakraborty K, Bossaer J B, Patel R, Krishnan K
Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA.
J Oncol Pharm Pract. 2013 Jun;19(2):175-7. doi: 10.1177/1078155212447530. Epub 2012 Nov 15.
Chronic myeloid leukemia is characterized by a unique reciprocal translocation between chromosomes 9 and 22 resulting in deregulated tyrosine kinase activity. Tyrosine kinase inhibitors, such as imatinib, dasatinib, and nilotinib have revolutionized treatment of Chronic myeloid leukemia. However, tyrosine kinase inhibitors' use has presented new challenges in managing both acute and chronic toxicities, particularly 'off-target' toxicities like pleural effusion. Pleural effusions are seen less often with imatinib and very rarely with nilotinib. A 66-year-old male presented to emergency department with complaints of mild chest pain and dyspnea of 3 days duration with progressive worsening, including dyspnea at rest. Patient was currently taking nilotinib after failing imatinib for chronic myeloid leukemia. Nilotinib was put on hold. After exclusion of cardiac and pulmonary etiologies patient was treated for community acquired pneumonia with minimal improvement. Despite the very low incidence of pleural effusion with nilotinib (<1%), he was started on 20 mg of prednisone PO for 3 days. Patient had a dramatic improvement within 48 h after beginning prednisone. This treatment approach suggests that pleural effusions associated with nilotinib can be successfully treated in the same way as pleural effusions associated with dasatinib.
慢性髓性白血病的特征是9号和22号染色体之间发生独特的相互易位，导致酪氨酸激酶活性失调。酪氨酸激酶抑制剂，如伊马替尼、达沙替尼和尼洛替尼，彻底改变了慢性髓性白血病的治疗方式。然而，酪氨酸激酶抑制剂的使用在管理急性和慢性毒性方面带来了新的挑战，尤其是像胸腔积液这样的“脱靶”毒性。伊马替尼导致胸腔积液的情况较少见，而尼洛替尼导致胸腔积液的情况极为罕见。一名66岁男性因持续3天的轻度胸痛和呼吸困难就诊于急诊科，症状逐渐加重，包括静息时呼吸困难。该患者因慢性髓性白血病伊马替尼治疗失败后正在服用尼洛替尼。尼洛替尼停用。排除心脏和肺部病因后，患者接受社区获得性肺炎治疗，但改善甚微。尽管尼洛替尼导致胸腔积液的发生率极低（<1%），但仍开始给予患者口服20毫克泼尼松，疗程3天。患者在开始使用泼尼松后48小时内病情显著改善。这种治疗方法表明，与尼洛替尼相关的胸腔积液可以与与达沙替尼相关的胸腔积液一样成功治疗。
