Spontaneous Regression Of Dasatinib-related Primary Effusion Lymphoma-like Lymphoma
Hayashino, K., Meguri, Y., Yukawa, R., Komura, A., Nakamura, M., Yoshida, C., Yamamoto, K., Oda, W., & Imajo, K. (2023). Spontaneous regression of dasatinib-related primary effusion lymphoma-like lymphoma. International journal of hematology, 117(1), 137–142. https://doi.org/10.1007/s12185-022-03449-y
View Original Source →Abstract
Primary effusion lymphoma-like lymphoma (PEL-LL) shows a unique clinical presentation, characterized by lymphomatous effusions in the body cavities. PEL-LL may be associated with hepatitis C virus infections and fluid overload states; and owing to its rarity, no standard therapies have been established. We report a case of a 55-year-old woman who developed PEL-LL during treatment with dasatinib, for chronic myeloid leukemia (CML). She presented to our hospital with dyspnea lasting for approximately a month and showed pericardial and bilateral pleural effusions. The pericardial effusion was exudative, and cytopathological and immunophenotypic examinations showed numerous CD 20-positive, large atypical lymphoid cells, which were also positive for the Epstein-Barr virus gene. No evidence of lymphadenopathy or bone marrow infiltration was found. We diagnosed PEL-LL, immediately discontinued dasatinib, and performed continuous drainage of the pericardial effusions. Complete response was achieved, and remission was maintained for 15 months. Two months after discontinuation of dasatinib, she was administered imatinib and a deep molecular response for the CML was maintained. PEL-LL occurring during dasatinib treatment is rare. We compared the results of previous reports with this case, and found that early diagnosis of PEL-LL, discontinuation of dasatinib, and sufficient drainage can improve the prognosis of PEL-LL.
Case Details
Disease Location
Pleura, pericardium
Personal Characteristics
55-year-old woman
Clinical Characteristics
Presented to the hospital with leukocytosis. She was diagnosed with chronic myeloid leukemia (cml) and treated with dasatinib (70 mg/day). Mild bilateral pleural effusion was observed 3 months after the diagnosis. She received diuretics without thoracentesis, and the bilateral pleural effusion promptly disappeared. 2 months later, she presented to the emergency room after experiencing dyspnea on exertion for one month. Physical examination revealed sinus tachycardia, mild hypoxia, and lower leg edema. Chest radiography and CT revealed pericardial and bilateral pleural effusion. Transthoracic echocardiography (tte) revealed massive pericardial effusion and right ventricular diastolic collapse. Pericardiocentesis showed a bloody and exudative pericardial effusion. Ldh and adenosine deaminase levels in the pericardial effusion were elevated. Cytopathological examination showed numerous large atypical lymphoid cells, which were immunohistochemically positive for CD20, epstein-barr encoding region (eber), and the kappa chain, and mildly positive for tp53. Based on these findings, the patient was diagnosed with primary effusion lymphoma-like lymphoma (pel-ll). The patient discontinued dasatinib and underwent continuous pericardial drainage for 4 days.
Remission Characteristics
Tte revealed that the pericardial effusion had almost disappeared the following day. Dyspnea on exertion and lower leg edema improved; chest radiography showed that bilateral pleural effusion had disappeared without drainage
Treatment & Mechanisms
Clinical Treatment
Dasatinib, diuretics, thoracentesis, pericardiocentesis, pericardial drainage.
Non-Clinical Treatment
None reported