Dasatinib-Induced Hypopigmentation in Pediatric Patient with Chronic Myeloid Leukemia: A Case Report and Review of the Literature

Abstract

Dasatinib is an oral second-generation multitarget tyrosine-kinase inhibitor (TKI) that is efficacious in treating imatinib-resistant chronic myeloid leukemia (CML) or intolerant cases. Noncutaneous adverse effects with dasatinib are well known in the literature, most commonly cytopenias and fluid retention, while pigmentary abnormalities have rarely been reported. We report the case of a 12-year-old male known case of CML, who presented to dermatology clinic approximately 2 years after initiating dasatinib treatment, with new-onset hypopigmentation of his upper limb, upper chest, and both knees of six months' duration.

Cutaneous reactions to pediatric cancer treatment part II: Targeted therapy

“…Pigmentary changes have also been reported in children taking c-KIT inhibitors. 25,26 In a retrospective study evaluating imatinib for chronic lymphocytic leukemia (CLL) in 30 children, 60% developed skin hypopigmentation. 27 This AE may be expected given c-KIT's involvement in melanocyte development, migration, and survival and known association with pigmentary disorders such as piebaldism.…”

Dermatologic toxicities of targeted antineoplastic agents and immune checkpoint inhibitor therapy in pediatric patients: A systematic review

“…Brazzelli et al 68 . and Alharbi et al 67 . described hypopigmentation of the skin associated with dasatinib.…”

“…In one case, a biopsy was performed that showed decreased melanocytes and decreased basal layer melanin pigmentation. 67 Oro-Ayude et al 71 reported KP-like rash with both dasatinib and nilotinib, with biopsy results consistent with KP. Finally, Karaatmaca et al 69 reported successful desensitization to dasatinib in patients who developed a delayed urticarial rash.…”

“…Six case reports [67][68][69][70][71][72] described cAEs of Bcr-Abl kinase inhibitors in more detail. Mahon et al 70 reported two pediatric CML patients who developed biopsy-proven pseudoporphyria 1.75-2 years after starting imatinib (400-600 mg/day), with resolution after cessation of the drug.…”

“…Brazzelli et al 68 and Alharbi et al 67 described hypopigmentation of the skin associated with dasatinib. In one case, a biopsy was performed that showed decreased melanocytes and decreased basal layer melanin pigmentation.…”