title: Subdural Hematoma Associated with Dasatinib and Intrathecal Methotrexate Treatment in Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia.
abstract: Dasatinib has been associated with an increased risk of bleeding, with the most prominent risk noted in patients with advanced-stage chronic myeloid leukemia and thrombocytopenia. We herein report two cases of Philadelphia chromosome-positive acute lymphoblastic leukemia in which a subdural hematoma developed in association with low-dose (40-50 mg/day) dasatinib treatment and lumbar puncture for intrathecal methotrexate injection. Both patients were in complete remission, with normal platelet counts and coagulation status. We suggest that dasatinib, even at a low dose, may impair platelet aggregation and that lumbar puncture may increase the risk of a subdural hematoma (occasionally bilateral) in patients receiving dasatinib.
authors.affiliation: Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ureshino
authors.forename: Atsujiro
authors.initials: A
authors.lastname: Nishioka
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kojima
authors.forename: Haruna
authors.initials: H
authors.lastname: Kizuka
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sano
authors.forename: Takero
authors.initials: T
authors.lastname: Shindo
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kubota
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ando
authors.forename: Shinya
authors.initials: S
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069439:Dasatinib / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006408:Hematoma, Subdural / Q000139:chemically induced*; D006801:Humans; D007278:Injections, Spinal; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D000069439:Dasatinib; D008727:Methotrexate