Dasatinib-Induced T-Cell-Mediated Colitis: A Case Report and Review of the LiteratureShanshal M.a · Shakespeare A.e · Thirumala S.b · Fenton B.c · Quick D.P.d
aDivision of Hematology and Oncology, Texas Tech University School of Medicine, bDepartment of Pathology and cDivision of Gastroenterology, Department of Medicine, Covenant Health, and dHematology/Oncology, Joe Arrington Cancer Center, Covenant Health, Lubbock, Tex., and eDepartment of Medicine, Scott and White Memorial Hospital and Texas A&M University School of Medicine, Temple, Tex., USA
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Dasatinib is a potent inhibitor of the altered tyrosine kinase activity in disease states associated with BCR/ABL1. This agent has been shown to exhibit broad off-target kinase inhibition and immunomodulating properties. These effects may be responsible for dasatinib's unique side effects including a distinctive form of hemorrhagic colitis. We report a case of hemorrhagic colitis associated with dasatinib use in a patient with chronic myelogenous leukemia. Colon biopsies at the time of symptomatic colitis confirmed CD3+CD8+ T cell infiltration. The process rapidly resolved following drug discontinuation, but relapsed when rechallenged with a reduced dose of dasatinib. Colitis did not recur when the patient was treated with an alternative agent. A literature review of prior cases involving dasatinib-induced T-cell mediated colitis provides insight into commonalities that may facilitate the recognition and management of this entity. Most incidences occurred after a 3-month drug exposure and may be accompanied by large granular lymphocytes. The process uniformly resolves within a few days following drug discontinuation and will generally recur in a shorter period of time if the drug is reintroduced. Most patients will require an alternative agent, although select patients could be continued on dasatinib if other options are limited.
© 2016 S. Karger AG, Basel
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