title: Dasatinib-Induced T-Cell-Mediated Colitis: A Case Report and Review of the Literature.
abstract: Dasatinib is a potent inhibitor of the altered tyrosine kinase activity in disease states associated with BCR/ABL1. This agent has been shown to exhibit broad off-target kinase inhibition and immunomodulating properties. These effects may be responsible for dasatinib's unique side effects including a distinctive form of hemorrhagic colitis. We report a case of hemorrhagic colitis associated with dasatinib use in a patient with chronic myelogenous leukemia. Colon biopsies at the time of symptomatic colitis confirmed CD3+CD8+ T cell infiltration. The process rapidly resolved following drug discontinuation, but relapsed when rechallenged with a reduced dose of dasatinib. Colitis did not recur when the patient was treated with an alternative agent. A literature review of prior cases involving dasatinib-induced T-cell mediated colitis provides insight into commonalities that may facilitate the recognition and management of this entity. Most incidences occurred after a 3-month drug exposure and may be accompanied by large granular lymphocytes. The process uniformly resolves within a few days following drug discontinuation and will generally recur in a shorter period of time if the drug is reintroduced. Most patients will require an alternative agent, although select patients could be continued on dasatinib if other options are limited.
authors.affiliation: Division of Hematology and Oncology, Texas Tech University School of Medicine, Lubbock, Tex., USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shanshal
authors.forename: Andrew
authors.initials: A
authors.lastname: Shakespeare
authors.forename: Seshadri
authors.initials: S
authors.lastname: Thirumala
authors.forename: Boyd
authors.initials: B
authors.lastname: Fenton
authors.forename: Donald P
authors.initials: DP
authors.lastname: Quick
mesh_terms: D003092:Colitis / Q000139:chemically induced; D000069439:Dasatinib; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000139:chemically induced; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013601:T-Lymphocytes; D013844:Thiazoles
chemical_list: D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013844:Thiazoles; D000069439:Dasatinib