Development of severe sclerotic chronic GVHD during treatment with dasatinib

Imatinib and dasatinib as salvage therapy for sclerotic chronic graft-vs-host disease

“…However, the small number of patients in our series is a significant limitation, and many additional issues remain unexplained, such as the pathophysiology of scGVHD and the factors predicting the successful use of TKI in this setting. This is emphasized in an interesting case report by Pulanic et al ( 25 ), where an allogeneic stem cell transplant recipient developed severe scGVHD while on dasatinib treatment due to persistence of residual chronic myeloid leukemia after transplant. Further larger studies and clinical trials are warranted to determine appropriate patient selection, optimal doses, and duration of therapy for immunosuppressed patients.…”

Dasatinib as Salvage Therapy for Steroid Refractory and Imatinib Resistant or Intolerant Sclerotic Chronic Graft-versus-Host Disease

“…This allowed us to discontinue corticosteroids in 2 cases and to reduce to \10% of the initial dose in the third case. The complexity of the pathophysiology underlying scGVHD and our limited understanding of the mechanisms of action and the factors predicting success of the use of TKI in this setting is emphasized by an interesting case reported by Pulanic et al [22] where an alloBMT recipient developed severe scGVHD while on treatment with dasatinib for persistence of residual CML after transplant. On the other hand, although dasatinib was first approved for CML only in patients who were resistant or intolerant to IM, recent studies have shown that first-line dasatinib treatment does induce significantly higher and faster response rates than IM [23].…”

Graft-versus-host disease

“…The role of the ''second-generation'' tyrosine kinase inhibitors (nilotinib and dasatinib) in the prophylaxis and treatment of GVHD also remains to be determined. 91,92 Other systemic therapies Key points d Limited data are available to support the use of antietumor necrosis factor-alpha therapy in chronic graft-versus-host disease d The use of antietumor necrosis factor-alfa therapy in the posteallogeneic transplant setting has been associated with invasive fungal infections Etanercept 93-95 and inflixamab 96,97 have been used for the treatment of acute GHVD, particularly in patients with steroid-refractory gastrointestinal disease; however, clinical experience in chronic disease is limited. 94,98 Enthusiasm for these agents in the treatment of GVHD has been tempered by the significant risk of invasive fungal infections.…”