Yang Lan, Lu Na, Jing Yu, Yu Li
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China. E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2016 Oct;24(5):1348-1353. doi: 10.7534/j.issn.1009-2137.2016.05.012.
To study the clinical features and prognosis of chylothorax related with dasatinib in treatment of chronic myeloid leukemia(CML).
The clinical data from 3 cases of CML with chylothorax after the treatment with dasatinib were collected. The clinical characteristics were analyzed and compared in the light of published literatures.
They were treated with imatinib 400 mg once daily after diagnosing the illness as CML. The patients achieved optimal response after switching to dasatinib 100 mg once daily when didn't resisted or endured to imatinib. However, the symptom of dyspnea occurred in the patient after dasatinib treatment for 8,19, and 24 months. The CT examination all showed pleural effusion. According to the results of the pleural effusion test, dasatinib-related chylothorax was diagnosed. Among them 1 case did not stop for dasatinib, only received the support treatment, up to now, the patient still in CMR. The effect of another case was not obvious after giving half dose of dasatinb. The symptoms was disappeared after stopping dasatinb, but there was still a small amount of pleural effusion. Currently, he was been given imatinib 400 mg once a day. The third case stopped taking dasatinib for 48 days, fasting for 35 days, supporting parenteral nutrition and basic therapy. Ligation of thoracic duct was also used to reduce pleural effusion. At present, the patient continued to dasatinib and the symptoms of chest distress disappeared, promising review to the hospital in 3 months.
The second-generation TKI dasatinib can lead to serious chylothorax in treatment of CML, timely and appropriate intervention are necessary when finding early detection of lung symptoms.
研究达沙替尼治疗慢性髓性白血病（CML）相关乳糜胸的临床特征及预后。
收集3例CML患者达沙替尼治疗后发生乳糜胸的临床资料，并结合已发表文献分析比较其临床特点。
3例患者确诊为CML后均先接受伊马替尼400mg每日1次治疗，对伊马替尼未耐药或不耐受者换用达沙替尼100mg每日1次后均获得最佳反应。但3例患者在达沙替尼治疗8、19和24个月后均出现呼吸困难症状，CT检查均提示胸腔积液，经胸腔积液检查结果确诊为达沙替尼相关乳糜胸。其中1例未停用达沙替尼，仅给予支持治疗，目前患者仍处于完全细胞遗传学缓解（CMR）状态；另1例给予半量达沙替尼后效果不明显，停用达沙替尼后症状消失，但仍有少量胸腔积液，目前给予伊马替尼400mg每日1次治疗；第3例停用达沙替尼48天，禁食35天，给予肠外营养支持及基础治疗，并采用胸导管结扎术减少胸腔积液。目前患者继续服用达沙替尼，胸闷症状消失，3个月后拟返院复查。
第二代酪氨酸激酶抑制剂（TKI）达沙替尼治疗CML可导致严重乳糜胸，早期发现肺部症状时需及时、恰当干预。
