title: Dasatinib-Induced Colitis after Allogeneic Stem Cell Transplantation for Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia.
abstract: The tyrosine kinase inhibitor dasatinib is often used after allogeneic hematopoietic cell transplantation to treat minimal residual disease in Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). Colitis, sometimes hemorrhagic, has occasionally been described with the use of dasatinib for both chronic myeloid leukemia and Ph+ ALL. The pathogenesis of dasatinib-induced colitis is unclear but may be related to effects of dasatinib on immune function. We describe a series of 5 patients who had 7 episodes of colitis during dasatinib use. No patient had obvious large granular lymphocytosis in peripheral blood. The histopathologic and immunohistochemical features of these cases were indistinguishable from control cases of gut graft-versus-host disease (GVHD). In all patients symptoms resolved upon discontinuation of dasatinib in addition to therapy with local or low-dose systemic steroids. An additional 3 patients who developed cytomegalovirus (CMV) colitis while on dasatinib therapy were identified and studied. Dasatinib colitis may have an immune-mediated mechanism similar to GVHD, and dasatinib use may be associated with CMV colitis. Awareness of this association is important for avoiding unnecessary intensification of immunosuppression for suspected gut GVHD.
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aldoss
authors.affiliation: Department of Pathology, City of Hope National Medical Center, Duarte, California.
authors.forename: Karl
authors.initials: K
authors.lastname: Gaal
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
authors.forename: Monzr M
authors.initials: MM
authors.lastname: Al Malki
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
authors.forename: Haris
authors.initials: H
authors.lastname: Ali
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Nakamura
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California. Electronic address: vpullarkat@coh.org.
authors.forename: Vinod
authors.initials: V
authors.lastname: Pullarkat
mesh_terms: D000328:Adult; D003092:Colitis / Q000139:chemically induced* / Q000175:diagnosis; D000069439:Dasatinib / Q000008:administration & dosage* / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D047428:Protein Kinase Inhibitors; D013256:Steroids / Q000627:therapeutic use; D014184:Transplantation, Homologous
chemical_list: D047428:Protein Kinase Inhibitors; D013256:Steroids; D000069439:Dasatinib
keywords: Allogeneic; Colitis; Dasatinib; Hematopoietic cell transplantation; Hemorrhagic