Dasatinib
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Primary effusion lymphoma: case report A 56-year-old woman developed primary effusion lymphoma during treatment with dasatinib for chronic myeloid leukaemia. The woman presented with abdominal distention and intermittent fever in August 2014. Following examinations, she was diagnosed with chronic myeloid leukaemia. She started receiving treatment with dasatinib 100mg daily [route not stated]. In August 2015, she developed persistent thrombocytopenia [aetiology unknown]. The dasatinib dose was reduced to 75mg daily. In March 2018, she developed hypertension [aetiology unknown]. The dasatinib dose was reduced to 50mg daily. In April 2018, she developed first episode of bilateral pleural effusion. The woman was treated with prednisolone. Subsequenlty, pleural effusion resolved. In May 2018, she experienced intermittent appearance of pleural effusion. She was treated with prednisolone or dexamethasone. She continued receiving dasatinib at 50mg daily. In July 2019, she developed second episode of massive pleural effusion. The first cytology specimen revealed numerous large atypical cells in a background of small neutrophils and lymphocytes. The large atypical cells were discohesive, with large vesicular nuclei, high nuclear/cytoplasmic ratio, multiple small to medium-sized nucleoli, irregular-shaped nuclear contours and little to moderate amount of cytoplasm. Immunocytochemistry was positive for CD19 cells which was suggestive of high-grade B-cell lymphoma consistent with primary effusion lymphoma. Subsequently, she underwent drainage of pleural effusion and received treatment with dexamethasone and prednisolone with resolution of pleural effusion. Her treatment with dasatinib was replaced with nilotinib. In August 2019, she developed third episode of massive pleural effusion. The second cytology specimen revealed same cellular feautures as of first cytology specimen. Immunocytochemistry was positive for CD79A, CD20, bcl-2, CD138, and PAX5 and diagnosed as large B-cell lymphoma. PCR based clonality study for gene rearrangement revealed BIOMED2 IGK tubes A and B reactions. Fluorescence in situ hybridization showed rearranged ICH genes. She discontinued treatment with nitotinib. She underwent pleurocentesis and received treatement with prednisolone with resolution of pleural effusion. In September 2019, she underwent bone marrow biopsy, which revealed features of chronic myeloid leukaemia without lymphoma involvement and blastic transformation. In November 2019, papillary carcinoma of right thyroid (3.7 cm; T2) without nodal metastasis was observed. Subsequently, she underwent radical thyroidectomy, right neck level VI LN dissection, and 131I ablation therapy. In January 2020, she had mild left pleural effusion and normal haemogram. She was treated with prednisolone. In March 2020, she developed fourth episode of massive left pleural effusion. The third cytology specimen diagnosed as large B-cell lymphoma. Subsequently, she underwent drainage of pleural effusion, and received treatment with prednisolone with resoluti
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