Journal of cardiology · 2019
The efficacy of tolvaptan in treating dasatinib-induced pleural effusions in patients with chronic myelogenous leukemia.
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Aoyama Rie, Ishikawa Joji, Harada Kazumasa
Аннотация
BACKGROUND: Cancer treatment has been developing significantly and cancer-related cardiovascular disease treatments such as various anticancer agents and molecular target drugs have been reported often in the era of oncocardiology. Chronic myeloid leukemia (CML) is a hematopoietic stem cell malignancy. Dasatinib is a novel tyrosine-kinase inhibitor approved for CML with Philadelphia (Ph) chromosome and the most common adverse effects of dasatinib are peripheral edema and pleural effusion, which sometimes impose the interruption or reduction of dosage of dasatinib treatment, accompanied by diuretic and steroid use. The goal of CML treatment is maintaining hematological control in the long term by controlling these side effects. The aim of this study is to clarify the efficacy of tolvaptan in treating dasatinib-induced fluid retention.
METHODS: We retrospectively analyzed six CML patients who received tolvaptan for dasatinib-induced fluid retention.
RESULTS: The mean age of patients was 60.5±11.5 years old, and the mean dosage of dasatinib and tolvaptan were 58.3±20.4mg/day and 5.0±1.9mg/day, respectively. Tolvaptan was introduced 564.5±369.9 days after dasatinib was introduced. Ejection fraction (EF) by echocardiography and brain natriuretic peptide (BNP) levels did not change. However, the diastolic function significantly changed [E/e' of the septal side: from 20.3±2.3 to 16.5±4.2, of the lateral side: from 15.0±2.1 to 12.5±3.8 (p<0.05, respectively)]. New York Heart Association functional class was improved from 3.3±0.5 to 1.5 ± 1.2 (p<0.01) and the grades of fluid retention were also improved. Three patients discontinued dasatinib, and two patients could restart the administration of dasatinib after controlling fluid retention. Five patients could control fluid retention and they could continue with dasatinib therapy without any complications.
CONCLUSIONS: Tolvaptan may be useful in fluid control in patients with CML treated with dasatinib.
METHODS: We retrospectively analyzed six CML patients who received tolvaptan for dasatinib-induced fluid retention.
RESULTS: The mean age of patients was 60.5±11.5 years old, and the mean dosage of dasatinib and tolvaptan were 58.3±20.4mg/day and 5.0±1.9mg/day, respectively. Tolvaptan was introduced 564.5±369.9 days after dasatinib was introduced. Ejection fraction (EF) by echocardiography and brain natriuretic peptide (BNP) levels did not change. However, the diastolic function significantly changed [E/e' of the septal side: from 20.3±2.3 to 16.5±4.2, of the lateral side: from 15.0±2.1 to 12.5±3.8 (p<0.05, respectively)]. New York Heart Association functional class was improved from 3.3±0.5 to 1.5 ± 1.2 (p<0.01) and the grades of fluid retention were also improved. Three patients discontinued dasatinib, and two patients could restart the administration of dasatinib after controlling fluid retention. Five patients could control fluid retention and they could continue with dasatinib therapy without any complications.
CONCLUSIONS: Tolvaptan may be useful in fluid control in patients with CML treated with dasatinib.