Dasatinib (Sprycel, Bristol Myers Squibb) has been implicated as a cause of pulmonary arterial hypertension (PAH). Several chemotherapeutic agents have been associated with PAH.
Dasatinib is a protein tyrosine kinase inhibitor that is used in Philadelphia chromosome positive chronic myelogenous leukemia (CML) and acute lymphoblastic leukemia (ALL).
Dasatinib should not be started if the patient has PAH or has risk factors for its development.
The onset of PAH may occur at any time after dasatinib has been started.
Symptoms of PAH may include:
(1) dyspnea
(2) hypoxemia
(3) peripheral edema
Diagnosis of PAH involves demonstrating that the mean pulmonary artery pressure is > 25 mm Hg at rest AND pulmonary artery wedge pressure is < 15 mm Hg. This may be done using echocardiography or right heart catheterization.
Dasatinib is implicated as the cause of the PAH if:
(1) there is no evidence for PAH prior to therapy
(2) other causes of pulmonary hypertension have been excluded
(3) discontinuation of the dasatinib results in reversal of the PAH
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