Vojjala Nikhil, Sami Hizqueel A, Kotla Nikhil Kumar, Peshin Supriya, Goyal Kanika, Kondaveety Soumya, Prabhu Rishab Rajendra, Krishnamoorthy Geetha
Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USA.
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Hematol Rep. 2025 Jan 31;17(1):7. doi: 10.3390/hematolrep17010007.
Tyrosine kinase inhibitors (TKIs) serve as the backbone in the management of chronic myelogenous leukemia and Philadelphia-positive Acute lymphoblastic Leukemia (Ph+ve ALL). With the growing use of TKIs, there has been an increase in adverse events related to these agents. Hereby, we present elderly women with Ph+ve ALL who developed recurrent pleural effusion, which was managed by switching the TKI and highlighting pleural effusion due to a third-generation TKI Bosutinib, adding to the minimal available literature. Our patient is a 79-year-old female with Ph+ve ALL diagnosed in 2015 and started on treatment. She is also on TKI maintenance initially with Imatinib later shifted to second-generation TKIs. She started developing worsening dyspnea related to pulmonary toxicity related to TKI in the form of pleural effusion. Pleural effusion was initially managed with diuretics, later requiring thoracocentesis. Because of persistent pleural effusion, she was changed to multiple TKIs and finally started on Bosutinib. She even developed progressive pleural effusion while on Bosutinib which is managed by thoracocentesis. Through this case report, we would like to highlight refractory recurrent pleural effusion caused by bosutinib adding to the minimal available literature. In addition, we highlight the various treatment options in patients having cross-intolerance to various TKIs, especially pulmonary toxicity, and ponatinib might be a suitable option in such cases.
酪氨酸激酶抑制剂（TKIs）是慢性粒细胞白血病和费城染色体阳性急性淋巴细胞白血病（Ph+ve ALL）治疗的基础。随着TKIs使用的增加，与这些药物相关的不良事件也有所增加。在此，我们报告一例患有Ph+ve ALL的老年女性，她出现了复发性胸腔积液，通过更换TKI进行治疗，并强调了第三代TKI波舒替尼引起的胸腔积液，目前关于这方面的文献极少。我们的患者是一名79岁女性，2015年被诊断为Ph+ve ALL并开始治疗。她最初接受伊马替尼进行TKI维持治疗，后来改用第二代TKIs。她开始出现与TKI相关的肺部毒性导致的进行性呼吸困难，表现为胸腔积液。胸腔积液最初用利尿剂治疗，后来需要胸腔穿刺术。由于胸腔积液持续存在，她更换了多种TKIs，最终开始使用波舒替尼。在使用波舒替尼期间，她甚至出现了进行性胸腔积液，通过胸腔穿刺术进行处理。通过本病例报告，我们想强调波舒替尼引起的难治性复发性胸腔积液，目前这方面的文献极少。此外，我们强调了对各种TKIs存在交叉不耐受（尤其是肺部毒性）的患者的各种治疗选择，在这种情况下，泊那替尼可能是一个合适的选择。
