Dasatinib‐related effusion lymphoma in a patient treated for chronic myeloid leukaemia

Miyagi, Daichi; Chen, Wei Yu; Chen, Bo Jung; Su, Ying; Kuo, Chun Chi; Karube, Kennosuke; Chuang, Shih Sung

doi:10.1111/cyt.12890

Cited by 8 publications

(9 citation statements)

References 9 publications

(28 reference statements)

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“…To the best of our knowledge, only four cases have reported a diagnosis of PEL-LL in patients showing effusions following dasatinib treatment for CML (Table 1) [13][14][15]. EBER was positive only in one case (case 3).…”

Section: Discussionmentioning

confidence: 94%

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Spontaneous regression of dasatinib-related primary effusion lymphoma-like lymphoma

et al. 2022

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Primary effusion lymphoma-like lymphoma (PEL-LL) shows a unique clinical presentation, characterized by lymphomatous effusions in the body cavities. PEL-LL may be associated with hepatitis C virus infections and fluid overload states; and owing to its rarity, no standard therapies have been established. We report a case of a 55-year-old woman who developed PEL-LL during treatment with dasatinib, for chronic myeloid leukemia (CML). She presented to our hospital with dyspnea lasting for approximately a month and showed pericardial and bilateral pleural effusions. The pericardial effusion was exudative, and cytopathological and immunophenotypic examinations showed numerous CD 20-positive, large atypical lymphoid cells, which were also positive for the Epstein-Barr virus gene. No evidence of lymphadenopathy or bone marrow infiltration was found. We diagnosed PEL-LL, immediately discontinued dasatinib, and performed continuous drainage of the pericardial effusions. Complete response was achieved, and remission was maintained for 15 months. Two months after discontinuation of dasatinib, she was administered imatinib and a deep molecular response for the CML was maintained. PEL-LL occurring during dasatinib treatment is rare. We compared the results of previous reports with this case, and found that early diagnosis of PEL-LL, discontinuation of dasatinib, and sufficient drainage can improve the prognosis of PEL-LL.

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Section: Discussionmentioning

confidence: 94%

“…PEL-LL during dasatinib treatment is very rare, with only four cases reported previously [13][14][15]. Herein, we present the case of a 55-year-old woman who was diagnosed with PEL-LL during treatment of CML with dasatinib and achieved complete remission by continuous drainage alone.…”

Section: Introductionmentioning

confidence: 94%

Spontaneous regression of dasatinib-related primary effusion lymphoma-like lymphoma

et al. 2022

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“…All cases exhibited similar aggressive cytomorphological features with large cells featuring a mature B‐cell non‐GCB immunophenotype without expression of plasma cell markers and harboring clonal IG gene rearrangements, 16–18 and only one case was EBV‐positive. Of the two cases investigated by FISH, one harbored a BCL6 gene rearrangement.…”

Section: Discussionmentioning

confidence: 94%

“…Two patients were Asians and the other two reported in Italy. All cases were HHV8‐negative 16–18 . The duration of dasatinib treatment prior to lymphoma diagnosis ranged between 2 and 8 years.…”

Section: Discussionmentioning

confidence: 99%

HHV8‐negative primary effusion‐based large B‐cell lymphoma in a patient with chronic myeloid leukemia, BCR::ABL1‐positive under dasatinib treatment: Report of a new case and literature review

Christe

Veloza

Gros

et al. 2022

Diagnostic Cytopathology

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Dasatinib, a second-generation tyrosine kinase inhibitor (TKI), used as treatment for chronic myeloid leukemia, BCR::ABL1-positive (CML), is complicated by pleural or pericardial effusions in about one-third of patients. Besides, in exceptional instances, effusion-based neoplastic B-cell lymphoproliferations have been described. Here, we report an HHV8-negative, EBV-positive large B-cell lymphoma presenting as a pericardial effusion in a patient with CML treated with dasatinib for 23 months, without associated tumor mass or lymphadenopathies. Large tumor cells showed a B-cell phenotype (CD20+, CD79+), with evidence of EBV infection (EBER-ISH+), but HHV8 (LANA-1) negative. Monoclonal IG gene rearrangements were identified. BCL2, BCL6, and MYC genes were not rearranged. Despite the aggressive cytomorphology the patient was in complete remission after 4 cycles of R-CHOP after 8 months followup. Four other cases of large B-cell effusion-based lymphomas developed in the setting of dasatinib therapy for CML have been reported in the literature. The four cases were HHV8-negative and one case was EBV-positive. Three of the four patients experienced a benign clinical course, which is in contrast to HHV8-positive primary effusion lymphoma (PEL). The mechanisms of development of these effusion-based B-cell lymphoproliferations in patients receiving TKI are not completely elucidated. Acute or relapsing effusions during TKI treatment in the setting of CML should be cytologically examined to exclude clonal B-cell lymphoproliferations.

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“…In the present report, we describe two exceptional cases of large B cell EBL arising under dasatinib treatment, as the first report of two consecutive cases in a single center after the first described patient in 2017, and the second single case just published late 2020 [15,16]. In the two patients, lymphoma was limited to the pleura at the time of diagnosis, therefore other subtypes of LPDs primarily presenting as pleural effusion had to be excluded.…”

mentioning

confidence: 81%

HHV8-Negative Effusion-Based Large B Cell Lymphoma Arising in Chronic Myeloid Leukemia Patients under Dasatinib Treatment: A Report of Two Cases

Fiori

Todisco

Ramadan

et al. 2021

Biology

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Tyrosine kinase inhibitors (TKIs) are the treatment of choice for BCR-ABL1-positive chronic myeloid leukemia (CML). Although TKIs have substantially improved prognosis of CML patients, their use is not free of adverse effects. Dasatinib is a second generation TKI frequently associated with pleural effusion in up to 33% of patients. This results in symptoms as dyspnea, cough and chest pain that may require therapy discontinuation. In the present report, we describe two exceptional cases of HHV8-negative large B-cell effusion-based lymphoma (EBL) confined to the pleura, incidentally, diagnosed in patients presenting with dasatinib-related pleural effusion. One patient (case 1) is alive and is in remission at 17 months from large B-cell EBL diagnosis while unfortunately the other patient (case 2) died of progressive disease and COVID-19 pneumonia 16 months from large B-cell EBL diagnosis. These cases raise concern about a possible association between large B-cell EBL and dasatinib, and the different clinical outcome of the two cases poses a challenge in treatment decision. For this reason, we strongly recommend cytological investigation in patients with persistent/relapsing pleural effusion under dasatinib, primarily to validate its possible association with lymphoma development and to improve the knowledge about this entity.

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Dasatinib‐related effusion lymphoma in a patient treated for chronic myeloid leukaemia

Cited by 8 publications

References 9 publications

Spontaneous regression of dasatinib-related primary effusion lymphoma-like lymphoma

Spontaneous regression of dasatinib-related primary effusion lymphoma-like lymphoma

HHV8‐negative primary effusion‐based large B‐cell lymphoma in a patient with chronic myeloid leukemia, BCR::ABL1‐positive under dasatinib treatment: Report of a new case and literature review

HHV8-Negative Effusion-Based Large B Cell Lymphoma Arising in Chronic Myeloid Leukemia Patients under Dasatinib Treatment: A Report of Two Cases

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