images in haematology
Dasatinib-induced gastric antral vascular ectasia in a patient with acute lymphoblastic leukaemia
A 46-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukaemia achieved a complete molecular response with induction therapy including imatinib. However, imatinib was discontinued because of persistent nausea and severe oedema of both lower limbs. He received consolidation therapy, which comprised high-dose cytarabine, high-dose methotrexate and methylprednisolone and, subsequently, dasatinib. On day 9, 6 days after starting dasatinib, he developed melaena and prolonged anaemia requiring the transfusion of 12 units of red blood cells during the following 2 weeks. Upper gastrointestinal endoscopy on day 23 revealed oozing from scattered mucosal erosions in the gastric antrum with a ‘watermelon appearance’ (left), which was indicative of gastric antral vascular ectasia (GAVE). Because of the suspicion of drug-induced GAVE, dasatinib was discontinued and his symptoms improved soon after drug cessation. The complete resolution of GAVE was
First published online 8 April 2015 doi: 10.1111/bjh.13407
confirmed by a follow-up upper gastrointestinal endoscopy on day 42 (right). Gastric antral vascular ectasia accounts for up to 4% of all non-variceal upper gastrointestinal bleeding and is associated with underlying chronic diseases, particularly cirrhosis and autoimmune diseases. Although rare, some drugs, including imatinib, have also been reported to cause GAVE. Our patient demonstrates that other tyrosine kinase inhibitors can also be responsible. Awareness of this rare complication is important because GAVE can sometimes cause severe, acute bleeding in patients treated with tyrosine kinase inhibitors. Soichi Ohta1, Yuho Najima1 and Jun Imamura2 1
Division of Haematology, Tokyo Metropolitan Cancer and Infectious
Disease Centre, Komagome Hospital, and 2Division of Hepatology, Tokyo Metropolitan Cancer and Infectious Disease Centre, Komagome Hospital, Tokyo, Japan. E-mail: [email protected]
ª 2015 John Wiley & Sons Ltd British Journal of Haematology, 2015, 169, 612
Copyright of British Journal of Haematology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Dasatinib-induced gastric antral vascular ectasia in a patient with acute lymphoblastic leukaemia
A 46-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukaemia achieved a complete molecular response with induction therapy including imatinib. However, imatinib was discontinued because of persistent nausea and severe oedema of both lower limbs. He received consolidation therapy, which comprised high-dose cytarabine, high-dose methotrexate and methylprednisolone and, subsequently, dasatinib. On day 9, 6 days after starting dasatinib, he developed melaena and prolonged anaemia requiring the transfusion of 12 units of red blood cells during the following 2 weeks. Upper gastrointestinal endoscopy on day 23 revealed oozing from scattered mucosal erosions in the gastric antrum with a ‘watermelon appearance’ (left), which was indicative of gastric antral vascular ectasia (GAVE). Because of the suspicion of drug-induced GAVE, dasatinib was discontinued and his symptoms improved soon after drug cessation. The complete resolution of GAVE was
First published online 8 April 2015 doi: 10.1111/bjh.13407
confirmed by a follow-up upper gastrointestinal endoscopy on day 42 (right). Gastric antral vascular ectasia accounts for up to 4% of all non-variceal upper gastrointestinal bleeding and is associated with underlying chronic diseases, particularly cirrhosis and autoimmune diseases. Although rare, some drugs, including imatinib, have also been reported to cause GAVE. Our patient demonstrates that other tyrosine kinase inhibitors can also be responsible. Awareness of this rare complication is important because GAVE can sometimes cause severe, acute bleeding in patients treated with tyrosine kinase inhibitors. Soichi Ohta1, Yuho Najima1 and Jun Imamura2 1
Division of Haematology, Tokyo Metropolitan Cancer and Infectious
Disease Centre, Komagome Hospital, and 2Division of Hepatology, Tokyo Metropolitan Cancer and Infectious Disease Centre, Komagome Hospital, Tokyo, Japan. E-mail: [email protected]
ª 2015 John Wiley & Sons Ltd British Journal of Haematology, 2015, 169, 612
Copyright of British Journal of Haematology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
