Chronic myeloid leukemia patients who develop grade I/II pleural effusion under second-line dasatinib have better responses and outcomes than patients without pleural effusion

Abstract Dasatinib is a potent second generation TKI, and it is widely used in patients with CML, both in the up-front setting and failure after imatinib. Lymphocytosis in cases receiving dasatinib therapy has been shown to be associated with pleural effusion (PE) and better outcome. Although patien...

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Bibliographic Details
Published in:Leukemia research 2014-07, Vol.38 (7), p.781-787
Main Authors: Eskazan, Ahmet Emre, Eyice, Deniz, Kurt, Enes Ali, Elverdi, Tugrul, Yalniz, Fevzi Firat, Salihoglu, Ayse, Ar, Muhlis Cem, Ongoren Aydin, Seniz, Baslar, Zafer, Ferhanoglu, Burhan, Aydin, Yildiz, Tuzuner, Nukhet, Ozbek, Ugur, Soysal, Teoman
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Chronic myeloid leukemia
CML
Dasatinib
Female
Hematology, Oncology and Palliative Medicine
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - mortality
Lymphocytosis
Lymphocytosis - epidemiology
Male
Middle Aged
Neoplasm Grading
Pleural effusion
Pleural Effusion - epidemiology
Pleural Effusion - therapy
Protein Kinase Inhibitors - adverse effects
Pyrimidines - adverse effects
Survival Rate
Thiazoles - adverse effects
Treatment Outcome
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Summary:Abstract Dasatinib is a potent second generation TKI, and it is widely used in patients with CML, both in the up-front setting and failure after imatinib. Lymphocytosis in cases receiving dasatinib therapy has been shown to be associated with pleural effusion (PE) and better outcome. Although patients who gather lymphocytosis during dasatinib have superior responses, there is only little data about the correlation between PE, response rates, and survival. In order to answer this question, the aim of our study was to determine the frequency of PE and lymphocytosis among our CML patients receiving second-line dasatinib, and to compare the responses and outcomes between patients with or without PE. There were 18 patients (44%) who developed PE, in a total of 41 patients, with a median time of 15 months. Lymphocytosis was observed in nine patients (9/41, 22%) with a median duration of 6.5 months of dasatinib treatment. There were fourteen patients with at least one comorbidity that may play a role in the generation of PE. The cumulative MMR and CCyR rates were greater in PE+ patients ( p < 0.05). The PFS was significantly higher in PE+ group than PE− patients ( p = 0.013), also the OS was higher among PE+ patients than PE− group ( p = 0.042). In patients with a grade I/II PE, and durable responses under dasatinib, performing the management strategies for the recovery of effusion, together with continuing dasatinib can be a reasonable choice mainly in countries where third generation TKIs are not available. But alternative treatment strategies such as nilotinib or third generation TKIs can be chosen in patients with grade III/IV PE especially if the quality of life is severely affected.
ISSN:0145-2126
1873-5835
DOI:10.1016/j.leukres.2014.04.004