Blood Res.  2022 Mar;57(1):80-84. 10.5045/br.2021.2021198.

Dasatinib-induced reversible pulmonary arterial hypertension in a pediatric patient with BCR/ABL1+ lymphoblastic lymphoma from chronic myeloid leukemia

• Han Hj
• Hong KT
• Choi JY
• Lee SY
• Kang HJ

• KMID: 2527502
• DOI: http://doi.org/10.5045/br.2021.2021198

Figure

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  Fig. 1 Echocardiographic changes after discontinuation of dasatinib. The interventricular septum is marked with arrows. At diagnosis of pulmonary arterial hypertension, echocardiography showed mild tricuspid regurgitation (TR) with a velocity of 3.4 m/sec and a D-type interventricular septum (IVS). The estimated RV to RA pressure gradient was 47 mmHg (A) [8]. Only trivial TR with a velocity of 2.7–2.8 m/sec remained and the shape of the IVS improved to B-type a month after the discontinu-ation of dasatinib (B). After 3 months, the IVS was still flat (C). It recovered to almost normal 6 months after discontinuation of dasatinib, and the TR velocity was 1.5 m/sec (D).

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  Fig. 2 Changes in the hilar-to-thoracic index with clinical course. The hilar-to-thoracic index represents the ratio of the hilar width to the transverse diameter of the thorax and correlates well with the degree of pulmonary arterial hypertension. The treatment duration of dasatinib related to the onset of PAH is presented as a charcoal-colored zone. The hilar-to-thoracic index measured on the posteroanterior chest view (CPA) is marked with diamonds (◆), and the index on the anteroposterior chest view (CAP) is marked with a cross (x). Each chest X-ray marked was obtained with full inspiration and covered almost 8 ribs. The milestones are represented by stars (*,**,***,****,*****); discharge with discontinuation of imatinib even after recovery from neutropenic fever, diagnosis of BCR-ABL1+ LL, HSCT, initiation of FK with diagnosis of skin GVHD, and diagnosis of chronic GVHD, in sequence. On reviewing a previous investigation, the change started 20 months after HSCT and became distinct 5 months later. Abbreviations: aGVHD, acute graft-versus-host disease; BCR-ABL1+ LL, BCR-ABL1+ lymphoblastic lymphoma; FK, tacrolimus; GVHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; MMF, mycophenolate mofetil.

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