Nishimoto Mitsutaka, Nakamae Hirohisa, Matsumoto Kana, Morita Kunihiko, Koga Yuki, Momose Dai, Hino Masayuki
Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno, Osaka, Japan.
Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo, Kyotanabe, Kyoto, Japan.
Case Rep Hematol. 2017;2017:4027908. doi: 10.1155/2017/4027908. Epub 2017 Feb 23.
A 56-year-old man being treated for dilated cardiomyopathy presented with epigastralgia. He was diagnosed with ventricular tachycardia and Philadelphia chromosome-positive acute lymphoblastic leukemia. After treating incessant ventricular tachycardia, we commenced induction therapy for leukemia with dasatinib and prednisolone to minimize toxicity towards cardiomyocytes and the cardiac conduction system. Although dasatinib was temporarily withheld because of a recurrence of ventricular tachycardia, we rechallenged dasatinib while using bisoprolol and amiodarone and achieved a complete hematological response three weeks later. Although drug interactions between dasatinib and amiodarone were of concern, the blood concentration of each drug remained within the safe range after concomitant use, and there were no adverse cardiac effects such as QT prolongation after rechallenging dasatinib. Induction therapy with dasatinib and prednisolone may be an acceptable therapeutic option for Philadelphia chromosome-positive acute lymphoblastic leukemia with severe cardiac complications.
一名正在接受扩张型心肌病治疗的56岁男性出现上腹部疼痛。他被诊断为室性心动过速和费城染色体阳性急性淋巴细胞白血病。在治疗持续性室性心动过速后，我们开始用达沙替尼和泼尼松龙进行白血病诱导治疗，以尽量减少对心肌细胞和心脏传导系统的毒性。尽管由于室性心动过速复发暂时停用了达沙替尼，但我们在使用比索洛尔和胺碘酮的同时重新使用了达沙替尼，并在三周后实现了完全血液学缓解。尽管担心达沙替尼和胺碘酮之间的药物相互作用，但同时使用后每种药物的血药浓度仍保持在安全范围内，重新使用达沙替尼后也没有出现如QT延长等不良心脏效应。对于伴有严重心脏并发症的费城染色体阳性急性淋巴细胞白血病，用达沙替尼和泼尼松龙进行诱导治疗可能是一种可接受的治疗选择。
