Bosutinib
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Bosutinib Pulmonary arterial hypertension and pericardial effusion: case report
A 37-year-old woman developed pulmonary arterial hypertension and pericardial effusion while receiving treatment with bosutinib for chronic myeloid leukaemia (CML). The woman was diagnosed with CML in 2002. She received initial treatment with imatinib for 7 years. Imatininb was replaced by dasatinib due to alopecia, peripheral oedema and periorbital oedema [aetiology not stated]. She continued dasatinib for 5 years, without any symptoms of cardiopulmonary dysfunction. However, she developed proteinuria of 3g/24 hours due to the dasatinib. Therefore, in August 2014, she switched to bosutinib [dosage and route not stated]. Consequently, proteinuria improved. In May 2018, she presented with a 6 months history of progressive dyspnoea. Echocardiography showed a large pericardial effusion with strong evidence of tamponade, i.e inversion of the right atrium (RA) and right ventricle (RV) and a swinging appearance. The RV was moderately dilated. Electrocardiogram revealed electrical alternans. The woman was admitted in a hospital and underwent pericardiocentesis. The pericardial effusion was possibly due to bosutinib, and therefore, the bosutinib was discontinued. After pericardiocentesis, her dyspnoea improved. Repeat echocardiography revealed RV systolic pressure as 52 mmHg, and severely enlarged RV, moderately reduced RV systolic function and moderate RA enlargement. Interventricular septum was flattened, and she did not have features of left-sided heart disease. No residual pericardial effusion was noted. Therefore, bosutinib induced severe pulmonary hypertension was suspected. Cardiac MRI did not show any evidence of a direct myocardial or pericardial pathology. Right heart catheterisation (RHC) revealed pre-capillary pulmonary hypertension. However, she continued to improve clinically following the withdrawal of bosutinib. In November 2018, her 6 minute walk distance was 585m, and echocardiogram showed moderate RV dilation, mildly reduced RV systolic function, normal RA size, and no pericardial effusion. In January 2019 repeated RHC revealed partial haemodynamic improvement. In June 2019 (13 months following the discontinuation of bosutinib), a repeated RHC revealed persistent pulmonary arterial hypertension and her 6 min walk distance was 577m. Echocardiography showed mild RV dilation, mildly reduced RV systolic function, normal RA size, and no pericardial effusion. Thus, she started receiving macitentan for pulmonary arterial hypertension, and she also started nilotinib for CML. Six months later (in December 2019), she was clinically stable and findings revealed that she had near-normal haemodynamics. Yo S, et al. Incident pulmonary arterial hypertension associated with Bosutinib. Pulmonary Circulation 10: No. 3, 1 Jul 2020. Available from: URL: http:// doi.org/10.1177/2045894020936913
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Reactions 19 Sep 2020 No. 1822
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