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

Abstract

Abstract 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 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.

Keywords

• chronic myeloid leukemia
• dasatinib
• echocardiography
• pulmonary arterial hypertension
• right ventricular systolic pressure