Pleural effusion (PE) represents the leading cause of dasatinib (DAS) discontinuation. However, the pathogenic mechanism of this adverse event (AE) is unknown and its management unclear. We investigated if a DAS dose reduction after the first PE would prevent the recurrence of this AE. We retrospectively collected data on all the cases of PE in CML-chronic phase (CP) DAS-treated patients from November 2005 to February 2017 in 21 Italian hematological centers. We identified 196 cases of PE in a series of 853 CML-CP DAS-treated patients (incidence 23.0%). DAS starting dose was 100 mg/day in 70.4% of patients, less than 100 mg/day in 14.3%, and more than 100 mg/day in the remaining cases. Median time from DAS start to PE was 16.6 months. At first PE development, 28.6% of patients were in MMR, and 37.8% in deep molecular response (DMR). DAS was temporary interrupted in 71.9% of cases, with a dose reduction in 59.2%. Recurrence was observed in 59.4% of the cases. Treatment was definitively discontinued due to PE in 29.1% of the cases. Interestingly, among patients whose DAS dosage was reduced, 59.5% experienced PE recurrence. DAS dose reduction after the first episode of PE did not prevent recurrence of this AE. Therefore, once a MMR or a DMR is achieved, different strategies of DAS dose management can be proposed prior to the development of PE, such as daily dose reduction or, as an alternative option, an on/off treatment with a weekend drug holiday.
Pleural effusion and molecular response in dasatinib-treated chronic myeloid leukemia patients in a real-life Italian multicenter series / A. Iurlo, S. Galimberti, E. Abruzzese, M. Annunziata, M. Bonifacio, R. Latagliata, P. Pregno, D. Ferrero, F. Sorà, E.M. Orlandi, C. Fava, D. Cattaneo, C. Bucelli, G. Binotto, E. Pungolino, M. Tiribelli, A. Gozzini, G. Gugliotta, F. Castagnetti, F. Stagno, G. Rege-Cambrin, B. Martino, L. Luciano, M. Breccia, S. Sica, M. Bocchia, F. Pane, G. Saglio, G. Rosti, G. Specchia, A. Cortelezzi, M. Baccaran. - In: ANNALS OF HEMATOLOGY. - ISSN 0939-5555. - 97:1(2018), pp. 95-100.
|Titolo:||Pleural effusion and molecular response in dasatinib-treated chronic myeloid leukemia patients in a real-life Italian multicenter series|
|Parole Chiave:||Chronic myeloid leukemia; Dasatinib; Dose reduction; Molecular response; Pleural effusion; Adult; Aged; Aged, 80 and over; Dasatinib; Female; Gene Expression Regulation, Leukemic; Humans; Italy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Pleural Effusion; Recurrence; Retrospective Studies; Treatment Outcome; Young Adult; Hematology|
|Settore Scientifico Disciplinare:||Settore MED/15 - Malattie del Sangue|
|Data di pubblicazione:||2018|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1007/s00277-017-3144-1|
|Appare nelle tipologie:||01 - Articolo su periodico|