Skride Andris, Sablinskis Matiss, Sablinskis Kristaps, Lesina Krista, Lejnieks Aivars, Lejniece Sandra
Riga Stradins University, Riga, Latvia.
Pauls Stradins Clinical University Hospital, Riga, Latvia.
J Med Case Rep. 2017 Dec 29;11(1):362. doi: 10.1186/s13256-017-1515-9.
There have been several reports on dasatinib-induced reversible pulmonary hypertension. This is the first reported case in Latvia; the patient did not discontinue the drug after the first adverse effects in the form of pleural effusions, which we speculate led only to partial reversion of the disease.
A 67-year-old white man with chronic myelogenous leukemia was treated with the dual Src and BCR-ABL tyrosine kinase inhibitor dasatinib. After treatment with dasatinib he had multiple pleural effusions which were suspected to be caused by congestive heart failure. Later a transthoracic Doppler echocardiography and right-sided heart catheterization revealed severe pulmonary hypertension with pulmonary vascular resistance of 12 Wood units and mean pulmonary artery pressure of 53 mmHg. Computed tomography ruled out a possible pulmonary embolism; laboratory specific tests for human immunodeficiency virus, rheumatoid factor, and anti-nuclear antibodies were negative, and dasatinib-induced pulmonary arterial hypertension was diagnosed. A follow-up right-sided heart catheterization and 6-minute walk test done a month after the discontinuation of dasatinib showed significant improvement: mean pulmonary artery pressure of 34 mmHg and pulmonary vascular resistance of 4 Wood units.
Patients should always be closely monitored when using dasatinib for a prolonged time. Dasatinib-induced pulmonary hypertension may be fully reversible after the therapy is suspended, but the key factors involved are still unclear and need to be further studied.
已有多篇关于达沙替尼诱发可逆性肺动脉高压的报道。这是拉脱维亚首例报告病例；该患者在出现胸腔积液形式的首次不良反应后未停用药物，我们推测这仅导致了病情的部分逆转。
一名67岁的白人慢性髓性白血病男性患者接受了Src和BCR-ABL双重酪氨酸激酶抑制剂达沙替尼治疗。使用达沙替尼治疗后，他出现了多次胸腔积液，怀疑是由充血性心力衰竭引起的。后来经胸多普勒超声心动图和右侧心导管检查显示严重肺动脉高压，肺血管阻力为12伍德单位，平均肺动脉压为53 mmHg。计算机断层扫描排除了可能的肺栓塞；人类免疫缺陷病毒、类风湿因子和抗核抗体的实验室特异性检测均为阴性，诊断为达沙替尼诱发的肺动脉高压。停用达沙替尼一个月后进行的随访右侧心导管检查和6分钟步行试验显示有显著改善：平均肺动脉压为34 mmHg，肺血管阻力为4伍德单位。
长期使用达沙替尼时应始终密切监测患者。达沙替尼诱发的肺动脉高压在暂停治疗后可能完全可逆，但其中涉及的关键因素仍不清楚，需要进一步研究。
