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Dasatinib and Pleural Effusion

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Hi everyone,

I come here for research and help for my mother who was diagnosed with CML three years ago. She tried Imatinib first but it didn't work and she had intense side effects, she was switched to Dasatinib 100 mg/day in July 2020.

She recently developed a pleural effusion and it has grown quite large. They're putting her on lasik pills and pausing the dasatinib for one week. Then they may resume at a lower daily dose. Her numbers have been pretty stable for ~1.5 years (3.4 log reduction).

I'm curious if anyone has ever experienced this and successfully gotten rid of the pleural effusion and gone back on the TKI without issue and it continued working? Did the pleural effusion come back? She really doesn't want to switch pills as she can manage the side effects of this one.

Thank you all for your help,

Nicole

Hi, Nicole,

Many of us do quite well on dasatinib for the first 2 years or so and then a pleural effusion(s) develops. It might be better if they kept her off dasatinib until her effusion totally resolves and then restarted at 50mg. Lasix and steroids generally don't prove very effective, in my research.

I was off dasatinib for almost 9 weeks to allow the effusion to clear. I think my PCR was 1.3 when I restarted but I regained 0.1 within a year and I was negative by 2015 (2.5 years later). Unfortunately, my effusion returned after 6 years in 2018 and we could never get it to resolve. Long story...I switched to low dose nilotinib in 2020 and have not looked back. I am now on 150mg/day.

I don't think recurrence is most people's experience on low-dose dasatinib, some as low as 20mg/day, especially after 6 years but it is always a possibility. I tried everything to be able to stay on dasatinib because I felt best on it after a miserable first six months but it was not in the cards.

I think many people on here will agree that it works best to discontinue dasatinib until the effusion clears, especially since hers is large.

Good luck to you and your mother. It is great that you are trying to help her by reaching out to others with CML.

Pat

Hi Nicole,

I too had a pleural effusion when taking Sprycel 100 mgm and reduced dosage to 70 and then to 50 mgm, but finally had to get the pleural effusion removed. At that time the Sprycel was stopped for a couple of months. When I resumed Sprycel at 20 mgm daily, I have had no reoccurrence of the effusion and my PCR tests are 0.0000.
I had resumed the Sprycel at 20 mgm around March 2019. It has been 4 years now.
I wish your Mom the best with a plan that works for her.