CHEST Guidelines-A-68-Year-Old-Man-With-Chronic-Myelogenous-Leukemi

A-68-Year-Old-Man-With-Chronic-Myelogenous-Leukemi

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The document details a medical case involving a 68-year-old man with chronic myelogenous leukemia (CML) who developed a large unilateral pleural effusion. The patient exhibits symptoms of dyspnea on exertion but lacks other common symptoms such as cough or chest pain. He has been under treatment with dasatinib, a tyrosine kinase inhibitor (TKI), for five years, maintaining undetectable disease levels per BCR-ABL1 assays. The physical exam revealed decreased breath sounds over the left chest, and a chest ultrasound confirmed the presence of a large pleural effusion.<br /><br />Lab tests from thoracentesis showed elevated lymphocytes in slightly turbid, dark red fluid, fitting the profile of a dasatinib-associated effusion. Dasatinib is noted for causing lymphocytic exudative effusions and sometimes chylous effusions. While the exact mechanism of dasatinib-associated effusion isn't well understood, the connection to the immune system's response, especially with large granular lymphocytosis, is discussed. The effusion development seems more prevalent in patients with existing risk factors like heart disease or those receiving a twice-daily dasatinib dosage. <br /><br />Management strategies of dasatinib-associated effusions include dose adjustments or switching to other TKIs, with invasive measures like pleural catheterization being typically avoidable. The presented case managed the condition by switching from dasatinib to imatinib, avoiding diuretics or steroids, and ultimately observing a stable effusion size. This case exemplifies the importance of differentiating drug-induced effusions from other potential causes, emphasizing careful monitoring and individualized treatment planning. The article concludes with clinical insights and a review of relevant literature, highlighting dasatinib's role in managing CML and its side effects.

Keywords

chronic myelogenous leukemia

pleural effusion

dasatinib

tyrosine kinase inhibitor

dyspnea

lymphocytic exudative effusion

BCR-ABL1 assays

large granular lymphocytosis

imatinib

treatment management