Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
Invest New Drugs. 2020 Oct;38(5):1627-1632. doi: 10.1007/s10637-020-00932-3. Epub 2020 Apr 4.
Dasatinib is a tyrosine kinase inhibitor for the treatment of BCR-ABL-positive chronic myeloid leukaemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukaemia (ALL). Although fluid retention is a common adverse event associated with dasatinib, chylothorax is exceptionally rare. The pathological mechanism, clinical manifestation and management of dasatinib-induced chylothorax are completely unclear. A 71-year-old man treated with dasatinib for CML was admitted for progressive dyspnea. Computed tomography (CT) showed a pleural effusion that was more prominent on the right thoracic cavity. Thoracentesis showed thick milky pleural fluid, which was then confirmed as chylothorax by chylum qualitative tests and triglyceride measurements. Radionuclide lymphoscintigraphy yielded an obstruction at the end segment of the thoracic duct, but no leakage points were found. After excluding common causes, drug-induced chylothorax was presumed. Then, dasatinib was withdrawn, and 1 week later, chylothorax resolved. To further elucidate the relationship between the medication and chylothorax, dasatinib was resumed tentatively for 2 days. As expected, pleural effusion recurred soon. Based on these clinical manifestations, the diagnosis of dasatinib-induced chylothorax was identified. The patient was suggested to stop dasatinib and use an alternative drug as recommended by the haematologist. Pleural effusion is the common adverse reaction of dasatinib, but chylothorax is rare. Only six cases of dasatinib-induced chylothorax have been reported, and our patient is the seventh case. Once a patient with dasatinib treatment develops chylothorax, dasatinib should be considered one of the possible causes. If no other definitive aetiological factor is identified, dasatinib discontinuation might be the optimum scheme.
达沙替尼是一种酪氨酸激酶抑制剂，用于治疗 BCR-ABL 阳性慢性髓性白血病（CML）或费城染色体阳性急性淋巴细胞白血病（ALL）。尽管液体潴留是达沙替尼常见的不良反应，但乳糜胸非常罕见。达沙替尼引起乳糜胸的病理机制、临床表现和处理完全不清楚。一名 71 岁男性因 CML 接受达沙替尼治疗后因进行性呼吸困难入院。计算机断层扫描（CT）显示胸腔右侧胸腔积液更为明显。胸腔穿刺抽出浓稠乳白色胸腔积液，经乳糜定性试验和甘油三酯测量证实为乳糜胸。放射性核素淋巴闪烁显像显示胸导管末端段阻塞，但未发现漏点。排除常见原因后，推测为药物引起的乳糜胸。然后停用达沙替尼，1 周后乳糜胸缓解。为了进一步阐明药物与乳糜胸之间的关系，达沙替尼暂时重新使用 2 天。正如预期的那样，胸腔积液很快再次出现。基于这些临床表现，确定了达沙替尼引起的乳糜胸的诊断。建议患者停止使用达沙替尼，并按照血液学家的建议使用替代药物。胸腔积液是达沙替尼的常见不良反应，但乳糜胸很少见。仅有 6 例达沙替尼引起的乳糜胸病例报告，我们的患者是第 7 例。一旦接受达沙替尼治疗的患者出现乳糜胸，应考虑达沙替尼是可能的病因之一。如果未确定其他明确的病因，则停止达沙替尼可能是最佳方案。
