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academies
Archives of General Internal Medicine | Volume 2
&
April 04-05, 2018 | Miami, USA
International Conference on
Internal Medicine & Practice and Primary Care
International Meeting on
Breast Pathology & Cancer Diagnosis
Introduction:
Dasatinib
is
an
orally
available
chemotherapeutic tyrosine Kinase inhibitor approved for
CML found to be recognized for rare occurrence of a drug
induced immune reaction causing pleural effusions. Early
identification and treatment is important and different
management techniques such as dose interruption, complete
discontinuation and short term steroid managements have
been used although need to be more thoroughly studied.
Methods:
74 year old male with PMH CML on dasatinib
admitted for 5 month history grade 3 pleural effusions and
worsening dyspnea. His treatment of CML with Dasatinib
was changed approximately 10 months prior admission from
imatinib to dasatinib and over the preceding 5 months has
developed new symptomatic recurrent pleural effusions.
The PE was consistent with crackles bibasilar lower lobes
consistent with pleural effusions without JVD or edema. CXR
revealed Bilateral pleural effusion Right > Left requiring his
third thoracentesis inpatient within 3 months.
Results:
Pleural Fluid analysis revealed exudative lymphocyte
predominant 70 monocyte 30, ADA 7.5. Hospital course
without overt signs of infection afebrile, absent WBC. CXR
revealed Bilateral Pleural effusions Right> Left . Quantiferon
negative. Echo preserved EF. Therefore, obvious causes
of pleural effusion ruled out. Suspicion for drug induced
immune reaction was considered given the relationship with
recently initiating dasatinib. Management entailed dose
interruption and a short 1week of course of lowdose steroids
on discharge. Repeat CXR 2 weeks later revealed improved
bilateral pleural effusions with 85 % clinical improvement
reported by the patient.
Conclusion:
Dasatinib associated pleural effusions treated
with short term steroids and dose interruption provides
alleviation of clinical symptoms and improvement in
radiologic findings in short term management.
Speaker Biography
Parisa Mehran M.D Internal Medicine Resident at Jersey City Medical Center - Barnabas
Health Jersey City Medical Center - Barnabas Health St. George’s University Jersey City,
New Jersey
e:
parisanmehran@gmail.comSteroids and dose interruption in Dasatinib associated Pleural effusions
Parisa Mehran MD
Jersey City Medical Center, USA