Sanchez-Paz Laura, Tirado Zambrana Pernilla Seidi, Villa Poza Carlos, Hernández-Rivas José-Ángel, Landete Hernández Elena
Hematology Department, Infanta Leonor University Hospital, Avda Gran Via del Este, nº80, Vallecas, Madrid 28031, Spain.
Pathology Department, Infanta Leonor University Hospital, Madrid, Spain.
Ther Adv Hematol. 2024 Oct 25;15:20406207241291736. doi: 10.1177/20406207241291736. eCollection 2024.
Dasatinib is a second-generation tyrosine kinase inhibitor employed for chronic myeloid leukemia (CML) treatment that achieves high rates of prolonged and complete molecular responses (MR). Among the adverse effects reported, it has been associated with hemorrhagic complications, mainly due to its inhibiting effects on platelet functions. In addition, immune alterations induced by dasatinib may elevate the risk of bleeding and cytomegalovirus (CMV) infection, particularly in the gastrointestinal tract, thus contributing to the development of hemorrhagic colitis. In this case report, we highlight three cases of CML receiving treatment with dasatinib where CMV hemorrhagic colitis occurred. All of them exhibited iron deficiency anemia as a premature clinical manifestation in the absence of intestinal symptoms, unlike cases previously reported in the literature. CMV infection was confirmed with stool samples or tissue quantitative polymerase chain reaction and/or immunohistochemistry staining in colon biopsies. All three cases could be managed with valganciclovir and iron supplements in an outpatient setting. Management strategies of dasatinib during and after CMV infection varied, as they are not yet established and need to be individualized based on the gravity of symptoms and disease state. Iron deficiency anemia during dasatinib treatment should raise suspicion for the potential presence of CMV colitis, prompting endoscopic studies to rule out this complication, even if intestinal symptoms are not present.
达沙替尼是一种用于治疗慢性髓性白血病(CML)的第二代酪氨酸激酶抑制剂,可实现较高的长期完全分子反应(MR)率。在已报道的不良反应中,它与出血并发症有关,主要是由于其对血小板功能的抑制作用。此外,达沙替尼诱导的免疫改变可能会增加出血和巨细胞病毒(CMV)感染的风险,尤其是在胃肠道,从而导致出血性结肠炎的发生。在本病例报告中,我们重点介绍了3例接受达沙替尼治疗的CML患者发生CMV出血性结肠炎的情况。与先前文献报道的病例不同,所有患者在没有肠道症状的情况下均表现为缺铁性贫血这一早期临床表现。通过粪便样本或组织定量聚合酶链反应和/或结肠活检中的免疫组织化学染色确诊为CMV感染。所有3例患者均可在门诊使用缬更昔洛韦和铁补充剂进行治疗。CMV感染期间及之后的达沙替尼管理策略各不相同,因为尚未确立这些策略,需要根据症状的严重程度和疾病状态进行个体化处理。达沙替尼治疗期间的缺铁性贫血应引起对CMV结肠炎潜在存在的怀疑,即使没有肠道症状,也应促使进行内镜检查以排除这种并发症。