Change of right ventricular systolic pressure can indicate dasatinib‐induced pulmonary arterial hypertension in chronic myeloid leukemia

• Published in: Cancer medicine (Malden, MA) Vol. 10; no. 5; pp. 1515 - 1524
• Main Authors: Lee, Sung‐Eun, Hyun Kong, Jee, Kim, Soo‐Hyun, Jang, Eun‐Jung, Chung, Nack‐Gyun, Cho, Bin, Joong Oh, Suk, Jung, Hae‐Eok, Youn, Ho‐Joong, Chung, Woo‐Baek, Kim, Dong‐Wook
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2021; John Wiley and Sons Inc; Wiley
• Subjects: Blood pressure; Cardiovascular disease; Chronic myeloid leukemia; Clinical Cancer Research; Congenital diseases; Connective tissue; dasatinib; Diagnosis; Drug dosages; Echocardiography; Heart; Hypertension; Immune system; Laboratories; Leukemia; Medical screening; Myeloid leukemia; Original Research; Patients; Pleural effusion; Protein-tyrosine kinase; pulmonary arterial hypertension; Pulmonary hypertension; right ventricular systolic pressure; Stem cell transplantation; Stem cells; Ventricle; chronic myeloid leukemia; right ventricular systolic pressure; dasatinib; pulmonary arterial hypertension; echocardiography
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3588

Background We investigated the feasibility of the clinical application of non‐invasive transthoracic echocardiography for diagnosis of pulmonary arterial hypertension induced by dasatinib (D‐PAH) in chronic myeloid leukemia (CML). Methods A total of 451 CML patients who were examined by 2D‐echocardiography at least once at baseline and/or during dasatinib therapy as frontline (n = 196) and subsequent line (n = 255) therapies were included in this study. D‐PAH was defined as right ventricular systolic pressure (RVSP) >40 mm Hg with relevant symptoms and the absence of other specific etiologies. Results A total of 847 echocardiographies were performed including at baseline (n = 255) and during dasatinib treatment (n = 592). During the median of 36.2 (0.1–181.8) months of dasatinib therapy, the level of RVSP gradually increased (Spearman's r = 0.2819, p < 0.001) and the mean RVSP was significantly increased after taking dasatinib therapy compared with baseline. During dasatinib therapy, 56 (12.4%) patients had RVSP >40 mm Hg without (asymptomatic, n = 27, 48.2%) or with symptoms (D‐PAH, n = 29, 51.8%). All asymptomatic patients maintained dasatinib therapy without further symptoms and the D‐PAH patients ultimately switched to other tyrosine kinase inhibitors. After dasatinib discontinuation, 13 (45%) and 15 (52%) patients showed RVSP normalization and gradual decrease, respectively. Conclusions Our large cohort study demonstrated that the gradual increment of RVSP might be induced by dasatinib and non‐invasive echocardiography can be fast way for early diagnosis as well as for monitoring of D‐PAH. (a) The aim of this study was to investigate the fidelity of 2D‐echocardiography for diagnosis of pulmonary arterial hypertension induced by dasatinib (D‐PAH) in chronic myeloid leukemia. (b) The gradual increment of right ventricular systolic pressure might be induced by dasatinib and non‐invasive echocardiography can be fast way for early diagnosis as well as for monitoring of D‐PAH.