LIFE THREATENING COMPLICATION OF ANTINEOPLASTIC THERAPY: DASATINIB-INDUCED PNEUMONITIS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Tyrosine kinase inhibitors used in treatment of chronic myeloid leukemia can cause pulmonary toxicity. We present a case pneumonitis patient with CML treated the tyrosine inhibitor dasatinib that demonstrated rapid recovery when steroids CASE PRESENTATION: 28-year-old man history type 1 diabetes, hypertension, embolism anticoagulation for 6 months, and which he was started on two weeks prior to admission presented emergency room cough syncope. He found be hypotensive hypoglycemic. Workup showed acute kidney injury, leukocytosis (14000 cells/mm3) bilateral perihilar opacities chest xray. CT thorax dense consolidations along bronchovascular bundles extending periphery as ground glass opacities. empiric piperacillin-tazobactam suspected pneumonia. Lung perfusion scan low probability embolism. Echocardiogram ejection fraction > 70%, severe hypertension right ventricular pressure 66mmHg. The night his oxygen requirements increased from 2 liters nasal cannula 80% high flow cannula. transferred intensive care closer monitoring. Empiric vancomycin diuretics were added. Patient had progressive respiratory distress cardiac arrest. intubated during resuscitation. Return circulation achieved after 5 minutes full neurologic recovery. Methylprednisolone initiated at 125mg every 8 hours induced pneumonitis. Over next several days PEEP titrated down 14 cmH20 FiO2 100% 40%. extubated hospital day 6. DISCUSSION: Dasatinib toxicity 3 patterns – pleural effusion (10-35% patients), artery (PAH, 0.45-5%) (around 23% one series), latter seen our patient. drug should discontinued all cases. Decreasing dose is associated lower risk effusion. Treatment may include systemic steroids, diuretics/thoracentesis (for effusions) endothelin receptor antagonist/calcium channel blockers PAH). evidence support mainly comes observational studies. For stable patients pneumonitis, are held only discontinuation done. or rapidly deteriorating patients, prednisone (40-60mg) daily methylprednisolone (up 1gm days) Post recovery, rechallenge attempted case-by-case basis except PAH where favored. CONCLUSIONS: Antineoplastic treatments including serious Timely recognition starting important such REFERENCE #1: Cortes JE, Saglio G et al. Final 5-Year Study Results DASISION: Versus Imatinib Treatment-Naïve Chronic Myeloid Leukemia Patients Trial. J Clin Oncol. 2016 Jul;34(20):2333-40. Epub May 23. #2: Bergeron A, Réa D abnormalities leukemia: series. Am Respir Crit Med. 2007;176(8):814. 2007 Jun 28. #3: Radaelli F, Bramanti S Dasatinib-related alveolar pneumonia responsive corticosteroids. Leuk Lymphoma. 2006;47(6):1180. DISCLOSURES: no disclosure file Adrian Sarzynski; No relevant relationships by Sahib Singh, source=Web Response