Dasatinib Associated Pleural Complications‐ A Case Series

TL;DR

This case series shows that long-term use of dasatinib for chronic myeloid leukemia can cause pleural complications, which can be managed by adjusting the dose or switching treatments.

Contribution

The study presents a case series of late-onset dasatinib-induced pleural complications and demonstrates effective management strategies.

Findings

Dasatinib-induced pleural effusions occurred in four patients after 2–10 years of treatment.

Dose reduction or switching to another tyrosine kinase inhibitor resolved complications while maintaining molecular remission.

One patient with chylothorax required discontinuation of dasatinib and switch to nilotinib for resolution.

Abstract

Dasatinib, a second‐generation tyrosine kinase inhibitor, is highly effective in chronic myeloid leukaemia (CML) but is associated with pleural complications in approximately 28%–37% of patients. We report four patients with CML who developed dasatinib‐induced pleural effusion after prolonged treatment (2–10 years), including one case of chylothorax. All presented with dyspnea, and imaging with diagnostic thoracentesis confirmed exudative pleural effusions. One patient demonstrated triglyceride‐rich fluid consistent with chylothorax. Dose reduction of dasatinib to 50 mg/day led to complete clinical and radiological resolution in three patients while maintaining molecular remission. The fourth patient encountered recurrent chylothorax despite dosage modification and supportive therapy, necessitating permanent discontinuation of dasatinib and transition to nilotinib, resulting in sustained radiological resolution and continued molecular response. This case series highlights the spectrum of late‐onset dasatinib‐related pleural complications and demonstrates that timely dose modification or TKI switching can effectively manage toxicity while preserving oncological outcomes.

Dasatinib is an effective therapy for chronic myeloid leukaemia but may lead to pleural complications, including exudative effusions and rare chylothorax. This case series describes four patients who developed pleural effusions after long‐term dasatinib therapy, highlighting successful management through dose reduction or TKI switching. Early recognition and tailored intervention allowed all patients to maintain or regain molecular remission while achieving radiological resolution.

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