Low-dose dasatinib-induced chylothorax, pulmonary hypertension, and pericardial effusion in a patient with chronic myeloid leukemia: A case report and literature review

Medicine (Baltimore). 2025 Jan 17;104(3):e41328. doi: 10.1097/MD.0000000000041328.

Abstract

Rationale: Chylothorax is a rare adverse effect that is associated with dasatinib, a tyrosine kinase inhibitor administered for chronic myeloid leukemia (CML) treatment. Most reported cases have described standard dosing. In this case report, we described a 43-year-old male patient with CML who developed chylothorax after 4 years of low-dose dasatinib therapy. To the best of our understanding, this is the first case to report the simultaneous development of pulmonary hypertension, pericardial effusion, and dasatinib-induced chylothorax.

Patient concerns: A 43-year-old male patient with CML developed chylothorax after 4 years of low-dose dasatinib.

Diagnoses: The patient also developed pulmonary hypertension and pericardial effusion at the same time.

Interventions: Therapeutic interventions included thoracentesis, steroids, diuretics, and sildenafil. Dasatinib was discontinued and replaced with nilotinib, which resolved the chylothorax, pulmonary hypertension, and pericardial effusion.

Outcomes: Chylothorax occurs with long-term and low-dose dasatinib administration. Concurrent pulmonary hypertension and pericardial effusion, although infrequent, may occur. Prompt recognition, dasatinib discontinuation, and therapeutic interventions are crucial for optimizing outcomes.

Lessons: Close monitoring for these rare side effects is paramount even in patients on long-term or low-dose dasatinib.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects
  • Chylothorax* / chemically induced
  • Chylothorax* / drug therapy
  • Dasatinib* / administration & dosage
  • Dasatinib* / adverse effects
  • Humans
  • Hypertension, Pulmonary* / chemically induced
  • Hypertension, Pulmonary* / drug therapy
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive* / complications
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive* / drug therapy
  • Male
  • Pericardial Effusion* / chemically induced
  • Protein Kinase Inhibitors / administration & dosage
  • Protein Kinase Inhibitors / adverse effects

Substances

  • Dasatinib
  • Protein Kinase Inhibitors
  • Antineoplastic Agents