Guidelines for the management of pleural effusions during dasatinib treatment in chronic myeloid leukemia

Abstract

Dasatinib is indicated for chronic myeloid leukemia (CML) patients with resistance or intolerance to imatinib or as a first line therapy in chronic or blastic phase of the disease; it has 325-fold increase potency compared to imatinib and is active in mutated and unmutated resistant patients. Pleural effusions are therapy-related events that can occur in all subset of patients treated with this drug. Aim of this paper is to draw up clinical guidelines on the management of pleural effusions associated with dasatinib treatment. Recommendations are based upon the published data and clinical personal experience from a number of different centres. Incidence of pleural effusions in different dasatinib trials, the related pathogenetic mechanisms and the associated risk factors are discussed. Practical recommendations to manage pleural effusions were finally composed. Adequate monitoring of patients with predisposing factors is necessary in order to early identify subjects at risk of developing such complications as well as to correctly manage them.