TY - JOUR
T1 - Unexpected pancytopenia
T2 - Dasatinib induced aplastic anemia in chronic myeloid leukemia
AU - Feld, Jonathan
AU - Steinberg, Amir
AU - El Jamal, Siraj M.
AU - Shapira, Ilan
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2022/1
Y1 - 2022/1
N2 - Introduction: The use of TKIs in CML has dramatically altered the natural course of the disease and improved outcomes for patients. TKIs overall have a very favorable safety profile. Dasatinib, a second generation TKI, is commonly used as a first-line treatment option in CML. Case report: We describe the first two reported cases of first-line dasatinib induced aplastic anemia in CML. In both patients, pancytopenia occurred within one year of diagnosis/starting dasatinib. Both bone marrow biopsies showed hypocellularity with mild fibrosis and persistent BCR-Abl1 positivity. Management & outcome: Dose reduction was attempted without success in both patients. In one patient, multiple TKIs were trialed, while in the other, growth factor support was attempted; neither regimen was effective. Ultimately, the cytopenias associated with dasatinib were only resolved after immunosuppression in one patient and allogeneic stem cell transplant in the other patient. Discussion: Prior reports have shown that aplasia/aplastic anemia can rarely be associated with imatinib and nilotinib. Here we show that dasatinib can lead to this phenomenon as well. This diagnosis should be considered in patients with CML who unexpectedly develop cytopenias.
AB - Introduction: The use of TKIs in CML has dramatically altered the natural course of the disease and improved outcomes for patients. TKIs overall have a very favorable safety profile. Dasatinib, a second generation TKI, is commonly used as a first-line treatment option in CML. Case report: We describe the first two reported cases of first-line dasatinib induced aplastic anemia in CML. In both patients, pancytopenia occurred within one year of diagnosis/starting dasatinib. Both bone marrow biopsies showed hypocellularity with mild fibrosis and persistent BCR-Abl1 positivity. Management & outcome: Dose reduction was attempted without success in both patients. In one patient, multiple TKIs were trialed, while in the other, growth factor support was attempted; neither regimen was effective. Ultimately, the cytopenias associated with dasatinib were only resolved after immunosuppression in one patient and allogeneic stem cell transplant in the other patient. Discussion: Prior reports have shown that aplasia/aplastic anemia can rarely be associated with imatinib and nilotinib. Here we show that dasatinib can lead to this phenomenon as well. This diagnosis should be considered in patients with CML who unexpectedly develop cytopenias.
KW - Chronic myeloid leukemia
KW - acquired aplastic anemia
KW - allogeneic transplantation
KW - dasatinib
KW - tyrosine kinase inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85108373024&partnerID=8YFLogxK
U2 - 10.1177/10781552211026375
DO - 10.1177/10781552211026375
M3 - Article
C2 - 34152210
AN - SCOPUS:85108373024
SN - 1078-1552
VL - 28
SP - 232
EP - 236
JO - Journal of Oncology Pharmacy Practice
JF - Journal of Oncology Pharmacy Practice
IS - 1
ER -