scholarly journals Combination targeted pulmonary hypertension therapy in the resolution of Dasatinib-associated pulmonary arterial hypertension

2017 ◽  
Vol 7 (4) ◽  
pp. 803-807 ◽  
Author(s):  
Arun Jose ◽  
Hind Rafei ◽  
Jalil Ahari
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Myeloid Leukemia ◽  
Kinase Inhibitor ◽  
Vasodilator Therapy ◽  
Pulmonary Vasodilator ◽  
Hypertension Therapy ◽  
Pulmonary Arterial ◽  
Phosphodiesterase 5

Dasatinib is a small-molecule tyrosine kinase inhibitor used in the treatment of hematological malignancies. Pulmonary arterial hypertension (PAH) is a rare but known complication. The mainstay of treatment is cessation of Dasatinib, and while clinical improvement is rapid, complete hemodynamic resolution of pulmonary hypertension (PH) still remains exceedingly uncommon. We present a case of Dasatinib-induced PAH in a woman with chronic myeloid leukemia, who demonstrated rapid and complete clinical and hemodynamic resolution following treatment with combination pulmonary vasodilator therapy using an endothelin receptor antagonist and a phosphodiesterase-5 inhibitor. This case suggests there may be an association between the use of targeted PH medication in combination and the complete resolution of dasatinib-associated PAH, but further investigation is required.

Lupus-like symptoms with anti-RNP/Sm and anti-nuclear antibodies positivity: An extremely rare adverse event of dasatinib

2019 ◽  
Vol 26 (3) ◽  
pp. 738-741 ◽  
Author(s):  
Senem Maral ◽  
Sule Mine Bakanay ◽  
Orhan Kucuksahin ◽  
Imdat Dilek
Keyword(s):  
Adverse Event ◽  
Pulmonary Arterial Hypertension ◽  
Pleural Effusion ◽  
Chronic Myeloid Leukemia ◽  
Pericardial Effusion ◽  
Arterial Hypertension ◽  
Myeloid Leukemia ◽  
Kinase Inhibitor ◽  
Pulmonary Arterial ◽  
Dasatinib Treatment

Introduction Dasatinib is a potent tyrosine-kinase inhibitor which is used for chronic myeloid leukemia treatment. Pleural effusion is a frequent side effect in patients during dasatinib treatment. Pulmonary arterial hypertension is a rare and life-threatening adverse event of dasatinib. The relationship between dasatinib and autoimmune disorders is unclear, but there are reports of possible mechanisms that have triggered autoimmunity by dasatinib. Case report A 53-year-old male was diagnosed with chronic myeloid leukemia and initiated imatinib mesylate as a treatment. Imatinib was changed to dasatinib as the patient was unresponsive in the first year of treatment. In the fourth year of dasatinib when chronic myeloid leukemia was in both hematological and cytogenetical remission, the patient presented with bilateral massive exudative pleural effusion. Echocardiography was consistent with pericardial effusion with right ventricle enlargement and normal left-side cardiac function. Pulmonary arterial hypertension was diagnosed with high systolic pulmonary arterial pressure. When he had fever and arthralgia, further investigation showed positivity of anti-nuclear antibodies (1/160 titer) and anti-RNP/Sm, which have high specificity for the diagnosis of Systemic Lupus Erythematosus (SLE). Management and outcome Dasatinib was discontinued and nilotinib was initiated. As the pleural effusion persisted despite diuretics and methylprednisolone, mycophenolate mofetil was initiated as a steroid-sparing immune-suppressive agent. The lupus-like symptoms disappeared, and antibodies became undetectable after dasatinib discontinuation. Pericardial effusion improved and pleural effusion did not relapse. Discussion Screening for auto-antibodies may be recommended for patients with a history or symptoms of autoimmune disease before starting dasatinib. All patients who develop pleural effusion while on dasatinib treatment should be investigated for antibodies for lupus.

scholarly journals Pulmonary hypertension: reasonable selection of specific therapy

2018 ◽  
Vol 15 (1) ◽  
pp. 45-50
Author(s):  
N A Karoli ◽  
S I Sazhnova ◽  
A P Rebrov
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Structural Changes ◽  
Pulmonary Arteries ◽  
Endothelin Receptor Antagonists ◽  
Endothelin Receptor ◽  
Receptor Antagonists ◽  
Pulmonary Vasodilator ◽  
Pulmonary Arterial

Pulmonary hypertension is characterized with persistent increase in pulmonary vascular resistance leading to progressive worsening of right ventricular failure and death. The basis for pulmonary arterial hypertension is structural changes in pulmonary arteries and arterioles caused by endothelial dysfunction. Endothelin-1 is the main pathogenic trigger of pulmonary hypertension and potential target for therapeutic exposure. The efficacy of endothelin receptor antagonists is proved in various preclinical and clinical studies. In patients with pulmonary arterial hypertension, the efficacy of dual and selective endothelin receptor antagonists is comparable despite the varied activity against various receptors. Bosentan is the most widely used pulmonary vasodilator which improves exercise tolerance and decelerates disease progression.

scholarly journals Diagnosis and Management of Pulmonary Arterial Hypertension

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Jeanne Houtchens ◽  
Douglas Martin ◽  
James R. Klinger
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Vasodilator Therapy ◽  
Pulmonary Hemodynamics ◽  
Initial Symptoms ◽  
Pulmonary Arterial ◽  
High Index Of Suspicion ◽  
Phosphodiesterase 5

Pulmonary arterial hypertension is a rare disease, which requires a high index of suspicion to diagnose when patients initially present. Initial symptoms can be nonspecific and include complaints such as fatigue and mild dyspnea. Once the disease is suspected, echocardiography is used to estimate the pulmonary arterial (PA) pressure and to exclude secondary causes of elevated PA pressures such as left heart disease. Right heart catheterization with vasodilator challenge is critical to the proper assessment of pulmonary hemodynamics and to determine whether patients are likely to benefit from vasodilator therapy. Pathologically, the disease is characterized by deleterious remodeling of the distal pulmonary arterial and arteriolar circulation, which results in increased pulmonary vascular resistance. In the last fifteen years, medications from three different classes have been approved for the treatment of pulmonary arterial hypertension. These include the prostanoids, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors.

scholarly journals Reversible Pulmonary Arterial Hypertension Induced by Dasatinib in a Patient With Chronic Myeloid Leukemia

2017 ◽  
Vol 33 (4) ◽  
pp. 284-289 ◽  
Author(s):  
Atai Watanabe ◽  
Kazuaki Yokoyama ◽  
Nobuhiro Ohno ◽  
Kaoru Uchimaru ◽  
Naohide Yamashita ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Chronic Myeloid Leukemia ◽  
Arterial Hypertension ◽  
Transthoracic Echocardiography ◽  
Myeloid Leukemia ◽  
Kinase Inhibitor ◽  
Heart Function ◽  
Drug Discontinuation ◽  
Right Heart ◽  
Pulmonary Arterial

A case study is provided of dasatinib-induced pulmonary arterial hypertension (PAH) in a patient with chronic myeloid leukemia. This condition resolved completely within 2 months of drug discontinuation. Transthoracic echocardiography (TTE) data were obtained throughout the recovery process. After 30 months of dasatinib treatment, a woman in her 30s developed orthopnea and signs of right heart failure (leg edema, hepatomegaly, and weight gain). Transthoracic echocardiography indicated elevated mean pulmonary artery pressure, severely impaired systolic and diastolic right ventricular functions, and dilation of the right ventricle and atrium. Once dasatinib was discontinued, clinical symptoms improved rapidly, and follow-up TTE 2 months later showed normal right heart function. Treatment with an alternative tyrosine kinase inhibitor was initiated and has continued without recurrence of PAH. This case suggests that dasatinib, which inhibits a broad spectrum of tyrosine kinases, could cause reversible PAH; therefore, careful cardiopulmonary evaluation by TTE is necessary.

Management of pulmonary vasodilator therapy in three pregnancies with pulmonary arterial hypertension

2017 ◽  
Vol 43 (5) ◽  
pp. 935-938 ◽  
Author(s):  
Atsushi Daimon ◽  
Chizuko A. Kamiya ◽  
Naoko Iwanaga ◽  
Tomoaki Ikeda ◽  
Norifumi Nakanishi ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Vasodilator Therapy ◽  
Pulmonary Vasodilator ◽  
Pulmonary Arterial
Sign in / Sign up

Export Citation Format

Share Document