Successful treatment with low-dose dasatinib in a patient with chronic eosinophilic leukemia intolerant to imatinib

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  • IMAGAWA Jun
    Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University
  • HARADA Yuka
    Division of Radiation Information Registry, Research Institute for Radiation Biology and Medicine, Hiroshima University
  • YOSHIDA Tetsumi
    Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University
  • TARUTANI Miho
    Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University
  • KIMURA Akiro
    Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University
  • MATSUMOTO Kana
    Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts
  • MORITA Kunihiko
    Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts
  • HARADA Hironori
    Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University

Bibliographic Information

Other Title
  • ダサチニブ少量療法が有効であったイマチニブ不耐容慢性好酸球性白血病
  • 症例報告 ダサチニブ少量療法が有効であったイマチニブ不耐容慢性好酸球性白血病
  • ショウレイ ホウコク ダサチニブ ショウリョウ リョウホウ ガ ユウコウ デ アッタ イマチニブ フタイヨウマンセイ コウサンキュウセイ ハッケツビョウ

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A 77-year-old man with cough and dyspnea was admitted to hospital. Chest X-ray demonstrated reticulated shadows in the bilateral inferior lung fields and marked eosinophilia was detected in peripheral blood. Although he received steroid pulse therapy, eosinophilia became more serious and he was referred to our hospital. Bone marrow examination demonstrated a hypercellular marrow that consisted predominantly of dysplastic eosinophils with differentiation. FISH analysis of bone marrow cells demonstrated 4q12 deletion and RT-PCR analysis detected FIP1L1-PDGFRA fusion gene, leading to the diagnosis of chronic eosinophilic leukemia (CEL). Treatment with low-dose imatinib was immediately initiated; however, drug-induced systemic edema was progressive and became intolerable. Therefore, we changed imatinib to low-dose dasatinib (20 mg/day), resulting in complete molecular response of CEL after 3 months without any severe adverse effects. This is the first report on the efficacy of low-dose dasatinib for the treatment of CEL. The peak level (Cmax) of dasatinib in this patient was 55.3 nM, which exceeded the concentration of dasatinib required to inhibit cells with FIP1L1-PDGFRA by 50%. Thus, low-dose dasatinib with therapeutic drug monitoring can be a useful therapy for imatinib-intolerant CEL even in elderly patients.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 52 (7), 546-550, 2011

    The Japanese Society of Hematology

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