Nishimori Makoto, Honjo Tomoyuki, Kaihotsu Kenji, Sone Naohiko, Yoshikawa Sachiko, Imanishi Junichi, Nakayama Kazuhiko, Emoto Noriaki, Iwahashi Masanori
Division of Cardiology, Department of Internal Medicine, Shinko Hospital, Kobe, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Case Rep Cardiol. 2018 May 20;2018:3895197. doi: 10.1155/2018/3895197. eCollection 2018.
Pulmonary arterial hypertension (PAH) is a rare complication of dasatinib that was approved as a first-line therapy for chronic myelocytic leukemia (CML). A 24-year-old man presenting dyspnea at rest and leg edema was admitted to our hospital. He had been diagnosed with CML and prescribed dasatinib for 4 years. Chest X-ray showed significant bilateral pleural effusion and heart enlargement. Echocardiography revealed interventricular septal compression and elevated peak tricuspid regurgitation pressure gradient of 66.7 mmHg indicating severe pulmonary hypertension. After the other specific diseases to provoke PAH were excluded, he was diagnosed with dasatinib-induced PAH. Despite discontinuation of dasatinib and intravenous administration of diuretic for two weeks, World Health Organization (WHO) functional class was still II and mean pulmonary arterial pressure (PAP) was high at 37 mmHg. Therefore, we administered sildenafil and bosentan together as an upfront combination therapy three weeks after dasatinib discontinuation. Six months later, his symptoms improved to WHO functional class I and mean PAP was decreased to 31 mmHg. Although PAH is a rare complication of dasatinib, symptomatic patients prescribed with dasatinib should have an echocardiogram for PAH screening. Moreover, the upfront combination therapy would be a useful option for symptomatic patients after discontinuation of dasatinib.
肺动脉高压（PAH）是达沙替尼一种罕见的并发症，达沙替尼被批准作为慢性粒细胞白血病（CML）的一线治疗药物。一名24岁男性因静息时呼吸困难和腿部水肿入院。他被诊断为慢性粒细胞白血病，并服用达沙替尼4年。胸部X线显示双侧大量胸腔积液和心脏增大。超声心动图显示室间隔受压，三尖瓣反流峰值压力梯度升高至66.7 mmHg，提示严重肺动脉高压。排除其他可引发PAH的特定疾病后，他被诊断为达沙替尼诱导的PAH。尽管停用达沙替尼并静脉注射利尿剂两周，但世界卫生组织（WHO）功能分级仍为II级，平均肺动脉压（PAP）仍高达37 mmHg。因此，在停用达沙替尼三周后，我们联合使用西地那非和波生坦进行初始联合治疗。六个月后，他的症状改善至WHO功能分级I级，平均PAP降至31 mmHg。尽管PAH是达沙替尼罕见的并发症，但服用达沙替尼的有症状患者应进行超声心动图检查以筛查PAH。此外，初始联合治疗对于停用达沙替尼后的有症状患者将是一个有用的选择。
