Ureshino Hiroshi, Nishioka Atsujiro, Kojima Kensuke, Kizuka Haruna, Sano Haruhiko, Shindo Takero, Kubota Yasushi, Ando Toshihiko, Kimura Shinya
Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan.
Intern Med. 2016;55(18):2703-6. doi: 10.2169/internalmedicine.55.6966. Epub 2016 Sep 15.
Dasatinib has been associated with an increased risk of bleeding, with the most prominent risk noted in patients with advanced-stage chronic myeloid leukemia and thrombocytopenia. We herein report two cases of Philadelphia chromosome-positive acute lymphoblastic leukemia in which a subdural hematoma developed in association with low-dose (40-50 mg/day) dasatinib treatment and lumbar puncture for intrathecal methotrexate injection. Both patients were in complete remission, with normal platelet counts and coagulation status. We suggest that dasatinib, even at a low dose, may impair platelet aggregation and that lumbar puncture may increase the risk of a subdural hematoma (occasionally bilateral) in patients receiving dasatinib.
达沙替尼与出血风险增加相关，在晚期慢性髓性白血病和血小板减少症患者中风险最为显著。我们在此报告两例费城染色体阳性急性淋巴细胞白血病患者，他们在接受低剂量（40 - 50毫克/天）达沙替尼治疗并进行鞘内注射甲氨蝶呤的腰椎穿刺后发生了硬膜下血肿。两名患者均处于完全缓解状态，血小板计数和凝血状态正常。我们认为，即使是低剂量的达沙替尼也可能损害血小板聚集，并且腰椎穿刺可能会增加接受达沙替尼治疗患者发生硬膜下血肿（偶尔为双侧）的风险。
