达沙替尼治疗慢性髓系白血病导致乳糜胸3例

Chylothorax Related with Dasatinib in the Treatment of Chronic Myeloid Leukemia:Report of 3 Cases

目的:探讨慢性髓系白血病(CML)使用达沙替尼治疗过程中导致相关乳糜胸的临床特征及转归。方法:收集我院3例达沙替尼治疗CML过程中导致相关乳糜胸的临床资料,结合文献对其进行分析和总结。结果:3例患者确诊CML后均接受伊马替尼(400 mg,1/d)治疗,分别在耐药或不能耐受之后改服二代酪氨酸激酶抑制剂(TKI)达沙替尼(100 mg,1/d),获得最佳反应,但分别在服药8、19和26个月后出现喘憋气短症状,影像学检查示胸腔积液。给予胸腔穿刺术间断引流胸水,胸水化验结果提示为乳糜性积液。3例患者在CML治疗期间仅长期服用达沙替尼单一药物,结合临床病程,考虑为达沙替尼治疗相关乳糜胸。在治疗上,对其中1例未予停用达沙替尼,对症支持治疗后好转,疾病一直处于稳定状态;第2例达沙替尼剂量减半,效果不明显,停用达沙替尼后胸闷症状减轻,但仍有大量胸腔积液,手术治疗后改服伊马替尼(400 mg,1/d),胸腔积液明显减少,定期复查骨髓;另1例予以停服达沙替尼共48 d,行胸导管结扎术,禁食并肠外营养,治疗后积液逐渐减少,目前继续口服达沙替尼。结论:选择二代TKI达沙替尼治疗CML时,应警惕乳糜胸这个重要的副反应。早期出现肺部不适症状应及时正确处理,同时密切监测基因水平变化情况,避免CML病情进展。

Objective：To study the clinical features and prognosis of chylothorax related with dasatinib in treatment of chronic myeloid leukemia（CML）.Methods：The clinical data from 3 cases of CML with chylothorax after the treatment with dasatinib were collected.The clinical characteristics were analyzed and compared in the light of published literatures.Results：They were treated with imatinib 400 mg once daily after diagnosing the illness as CML.The patients achieved optimal response after switching to dasatinib 100 mg once daily when didn’t resisted or endured to imatinib.However,the symptom of dyspnea occurred in the patient after dasatinib treatment for 8,19,and 24 months.The CT examination all showed pleural effusion.According to the results of the pleural effusion test,dasatinib-related chylothorax was diagnosed.Among them 1 case did not stop for dasatinib,only received the support treatment,up to now,the patient still in CMR.The effect of another case was not obvious after giving half dose of dasatinb.The symptoms was disappeared after stopping dasatinb,but there was still a small amount of pleural effusion.Currently,he was been given imatinib 400 mg once a day.The third case stopped taking dasatinib for 48 days,fasting for 35 days,supporting parenteral nutrition and basic therapy.Ligation of thoracic duct was also used to reduce pleural effusion.At present,the patient continued to dasatinib and the symptoms of chest distress disappeared,promising review to the hospital in 3 months.Conclusion：The second-generation TKI dasatinib can lead to serious chylothorax in treatment of CML,timely and appropriate intervention are necessary when finding early detection of lung symptoms.