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Various toxicities: case report An approximately 66-year-old woman [exact age at initial reaction onset not stated] developed cardiac symptoms during treatment with dasatinib for refractory chronic myelogenous leukaemia (CML). She eventually developed pericardial and pleural effusions during treatment with imatinib, followed by diarrhoea during treatment with bosutinib [routes and times to reactions onsets not stated; not all dosages stated]. In 2004, the woman was diagnosed with refractory CML. In 2007 at the age of approximately 66 years, dasatinib was started. However, she developed cardiac symptoms which she described as her heart feeling like it was going to "flop out". Dasatinib was stopped after 1 month. At this point, the woman was started on interferon-α; however, interferon-α was stopped due to side-effects [specific reactions not stated]. In 2012, she started receiving imatinib 800 mg/day, subsequently lowered to 600mg daily. Concomitantly, she received hydroxycarbamide [hydroxyurea]. In January 2012, she developed pericardial and pleural effusions, most likely from imatinib, requiring pericardial window placement in the same month at hospital. Imatinib was switched to dasatinib 50mg daily, with close monitoring and plans to use pulse steroids and diuresis if fluid buildup developed. In March 2013, she was tolerating dasatinib, and her dose was increased to 50mg or 100mg every other day. In May 2013, she was found to be negative for BCR/ABL, but the PCR was still concerning. It was decided to initiate concomitant ponatinib. In January 2014, She was switched to bosutinib 300mg daily. Following switch to bosutinib, her BCR/ABL clones once again started to increase. She developed bouts of diarrhoea due to bosutinib, mainly when dosage increase was attempted. BCR/ABL levels rose in February 2016. In May 2016, BCR/ABL decreased from 65–52.3%. At this time, her bosutinib dose was increased to 500mg every day due to another rise in BCR/ABL. This elevated dose caused an increase in diarrhoea. Therefore, bosutinib dosage was again reduced to 300mg daily. Since that time in 2016, her BCR/ABL waxed and waned, but she continued in haematological remission. At the time of report, she was 75 years old and was still receiving bosutinib 300mg daily for about 5 years, with plans to add interferonα if disease progression was observed. Sobash PT, et al. Management of a 75-Year-Old Lady with Refractory Chronic Myelogenous Leukemia. Case Reports in Oncology 13: 534-537, No. 2, Jan 2020. Available 803520089 from: URL: http://doi.org/10.1159/000506895

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Reactions 12 Dec 2020 No. 1834