Dasatinib-induced immune mediated-thrombotic thrombocytopenic purpura

Demırsoy, Esra Terzı; Mehtap, Özgür; Atesoglu, Elif Birtas; Tarkun, Pınar; Eren, Necmi; Gedük, Ayfer; Hacıhanefioğlu, Abdullah

doi:10.1016/j.transci.2018.02.003

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…Moreover, tyrosine kinase inhibitors (TKI), particularly imatinib, have been related to the development of severe AA, possibly via an immunologic mechanism different from the classical bone marrow toxicity [67]. Imatinib and dasatinib have been also related to the onset of severe immune-mediated thrombotic microangiopathies, namely TTP and atypical hemolytic uremic syndrome, which resolved after drug cessation [86,87]. Regarding Ph-negative MPN, interferon therapy has been associated with TTP in a patient with polycythemia vera [89].…”

Section: Autoimmune Complications Associated With Old and New Anti-cancer Drugsmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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Autoimmune cytopenias (AICy) and autoimmune diseases (AID) can complicate both lymphoid and myeloid neoplasms, and often represent a diagnostic and therapeutic challenge. While autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) are well known, other rarer AICy (autoimmune neutropenia, aplastic anemia, and pure red cell aplasia) and AID (systemic lupus erythematosus, rheumatoid arthritis, vasculitis, thyroiditis, and others) are poorly recognized. This review analyses the available literature of the last 30 years regarding the occurrence of AICy/AID in different onco-hematologic conditions. The latter include chronic lymphocytic leukemia (CLL), lymphomas, multiple myeloma, myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), myeloproliferative neoplasms, and acute leukemias. On the whole, AICy are observed in up to 10% of CLL and with higher frequencies in certain subtypes of non-Hodgkin lymphoma, whilst they occur in less than 1% of low-risk MDS and CMML. AID are described in up to 30% of myeloid and lymphoid patients, including immune-mediated hemostatic disorders (acquired hemophilia, thrombotic thrombocytopenic purpura, and anti-phospholipid syndrome) that may be severe and fatal. Additionally, AICy/AID are found in about 10% of patients receiving hematopoietic stem cell transplant or treatment with new checkpoint inhibitors. Besides the diagnostic difficulties, these AICy/AID may complicate the clinical management of already immunocompromised patients.

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Section: Autoimmune Complications Associated With Old and New Anti-cancer Drugsmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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“…3 More cases with proteinuria have been reported with this therapy. [2][3][4][5][6][7][8][9] Table 1 summarizes details of all published cases of proteinuria with dasatinib and noted kidney biopsy findings. Cases have been described in both pediatric and adult literature for treatment in both CML and ALL.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathy in dasatinib-treated patients with chronic myeloid leukemia

Koshida

Suzuki

et al. 2019

Journal of Onco-Nephrology

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Dasatinib is the second-generation tyrosine kinase inhibitor used in the treatment of chronic myeloid leukemia. Proteinuria has been reported with this agent. We describe two kidney biopsy–proven cases of dasatinib-induced thrombotic microangiopathy that responded to stoppage of dasatinib and using an alternate tyrosine kinase inhibitor. Certain specific tyrosine kinase inhibitors lead to endothelial injury and renal-limited thrombotic microangiopathy. Hematologists and nephrologists need to be familiar with this off-target effect of dasatinib.

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“…Three cases have been reported after imatinib use, 13,14 and to our knowledge, only 2 cases of dasatinib-induced MAHA have been reported in the literature. 5,15 We believe that our patient had a side effect of the treatment of the underlying disease, CML (i.e., CML treated with dasatinib leading to TTP, which in turn provoked intracranial hypertension from the underlying anemia and thrombocytopenia).…”

mentioning

confidence: 94%

“…3,4 This process is usually caused by a genetic mutation in the ADAMTS13 gene or by an autoimmune process; however, it may also be triggered by infection, 3 pregnancy, 3,4 or medications. 5 Although pieces of the classic pentad are the most common presentation for TTP, ophthalmologic manifestations also rarely occur. We present a case of TTP secondary to dasatinib therapy with the ocular manifestation of papilledema.…”

mentioning

confidence: 99%

“…Dasatinib is a tyrosine kinase inhibitor that acts on BCR-ABL kinase and is used in the treatment of CML. 5 TTP is a rare disease characterized by the classic pentad of microangiopathic hemolytic anemia, thrombocytopenia with purpura, acute kidney injury, neurologic abnormality with fluctuating mental status, and fever. 1,2 Ocular manifestations of this disease are under-recognized and have been reported to occur in 14À20% of cases.…”

mentioning

confidence: 99%

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