Immunosuppression and atypical infections in CML patients treated with dasatinib at 140 mg daily
Article first published online: 9 SEP 2009
© 2009 The Authors. Journal Compilation © 2009 Stichting European Society for Clinical Investigation Journal Foundation
European Journal of Clinical Investigation
Volume 39, Issue 12, pages 1098–1109, December 2009
How to Cite
Sillaber, C., Herrmann, H., Bennett, K., Rix, U., Baumgartner, C., Böhm, A., Herndlhofer, S., Tschachler, E., Superti-Furga, G., Jäger, U. and Valent, P. (2009), Immunosuppression and atypical infections in CML patients treated with dasatinib at 140 mg daily. European Journal of Clinical Investigation, 39: 1098–1109. doi: 10.1111/j.1365-2362.2009.02206.x
- Issue published online: 9 NOV 2009
- Article first published online: 9 SEP 2009
- Received 6 May 2009; accepted 21 July 2009
- drug targets;
- side effects
Background The multikinase inhibitor dasatinib exerts growth-inhibitory effects in patients with imatinib-resistant chronic myeloid leukaemia (CML). In first clinical trials, side effects of dasatinib, 140 mg daily, were reported to be mild and tolerable.
Patients and methods We examined the side effect profile in 16 patients with imatinib-resistant CML who received 140 mg dasatinib daily in our center.
Results Dasatinib produced substantial and sometimes severe or even life-threatening side effects with ≥ 10% body weight loss (6/16 patients), pleural effusions grade II or higher (12/16) and infectious complications (12/16), including atypical infections not seen in imatinib-treated patients. One patient developed Epstein–Barr-Virus-positive mucosal leucoplakia, one died from pneumonia caused by pneumocystis carinii and three patients developed a skin-cancer. Most events were recorded within the first 2 years of therapy, only skin tumours developed after the second year. In ex vivo experiments performed in dasatinib-treated patients, transient suppression of IgE-dependent activation of blood basophils and TcR-dependent activation of T-lymphocytes was found. Moreover, in drug-binding studies, dasatinib was found to bind to several key kinase-targets of the immune system including Lyn and Btk, in mast cell, basophil, B-cell and T-cell lines.
Conclusion Dasatinib acts not only anti-neoplastic in CML but may also act as an immunosuppressive agent when applied at 140 mg daily, and produces frequent pleural effusions and weight loss in advanced CML.