Dasatinib followed by second allogeneic hematopoietic stem cell transplantation for relapse of Philadelphia chromosome-positive acute lymphoblastic leukemia after the first transplantation.
Although allogeneic hematopoietic stem cell transplantation (HSCT) is an established treatment for Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL), the prognosis of patients who relapse after allogeneic HSCT has been extremely poor. Dasatinib, a second-generation tyrosine kinase inhibitor, is a promising agent for the treatment of Ph-ALL. We report on a Ph-ALL patient who relapsed early after the first allogeneic HSCT, but achieved complete molecular remission with dasatinib alone. She remains in molecular remission 12 months after the second allogeneic HSCT. Dasatinib was generally well tolerated, but she developed myalgia, nausea and positive cytomegalovirus antigenemia. In addition, sudden-onset bloody diarrhea was observed 10 days after the second HSCT, which was possibly associated with the use of dasatinib in addition to the effect of the conditioning regimen and graft-versus-host disease. In conclusion, dasatinib is an effective agent for Ph-ALL with a poor prognosis, but may be associated with specific adverse events including opportunistic infection and gastrointestinal bleeding.
Ishida
Yoko
Y
Division of Hematology, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
Terasako
Kiriko
K
Oshima
Kumi
K
Sakamoto
Kana
K
Ashizawa
Masahiro
M
Sato
Miki
M
Kikuchi
Misato
M
Kimura
Shun-Ichi
S
Nakasone
Hideki
H
Okuda
Shinya
S
Kako
Shinichi
S
Yamazaki
Rie
R
Nishida
Junji
J
Kanda
Yoshinobu
Y
D000293:Adolescent; D000069439:Dasatinib; D005260:Female; D006086:Graft vs Host Disease / Q000473:pathology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000517:prevention & control* / Q000601:surgery; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D014184:Transplantation, Homologous
D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013844:Thiazoles; D000069439:Dasatinib
Cancer. 2009 Apr 1;115(7):1381-94
19195046
Hematology Am Soc Hematol Educ Program. 2009;:371-81
20008223
Transplantation. 2002 Feb 27;73(4):568-72
11889432
Blood. 2010 Sep 23;116(12):2070-7
20466853
J Clin Oncol. 2006 Jan 20;24(3):460-6
16344315
Cancer. 2007 Jul 15;110(2):340-4
17559140
Leukemia. 2009 Jan;23(1):190-4
18596746
Drug Metab Dispos. 2008 Jul;36(7):1357-64
18420784
Blood. 2009 Jul 9;114(2):261-3
19414863
Leukemia. 2009 Aug;23(8):1398-405
19295545
Am J Hematol. 2008 Mar;83(3):226-32
17918253
Bone Marrow Transplant. 2005 Nov;36(10):867-72
16113659
Exp Hematol. 2008 Oct;36(10):1297-308
18619726
Cancer. 2009 Jun 1;115(11):2482-90
19280591
Leuk Res. 2010 Feb;34(2):143-7
19481800
Blood. 2007 Oct 1;110(7):2309-15
17496201