Abstract 17358: Persistent Pericardial Effusion Secondary to Dasatinib Successfully Treated With Colchicine

Abstract

Introduction: Dasatinib is one of the first-line therapies for CML. A large pericardial effusion requiring drainage has rarely been documented among its adverse effects, and its treatment is still a subject of study. Case Presentation: A 44-year-old female with history of chronic myeloid leukemia (CML) in remission on Dasatinib for the past 10 years presented to the emergency with complaints of chest pain and palpitations for 3 weeks. Physical examination was remarkable for muffled heart sounds and tachycardia. No JVD, pulsus paradoxus, or hypotension were noted. A 12-lead EKG showed low voltage QRS in limb leads (A), and transthoracic echo (TTE) reported a moderate to large pericardial effusion with features concerning for early tamponade (B). A pericardiocentesis was performed with 500 mL of hemorrhagic fluid removed with a drain placed. Dasatinib was held but pericardial output remained elevated (>100 mL/day) for the following 12 days. Colchicine 0.6mg twice a day was then initiated. Cardiothoracic surgery recommended against a pericardial window. On day 15, the drain was able to be removed after a marked reduction in fluid output. Patient was discharged to complete 3 weeks of colchicine therapy. Two weeks later, the patient remained asymptomatic with no signs of recurrent pericardial effusion on a repeat TTE. Discussion: Dasatinib is associated with a range of reported side effects including development of pericardial effusions in a limited number of cases. Nonetheless, there is a dearth of information regarding their optimal treatment approach. Our case highlights the use of colchicine as a potential strategy for patients with persistent Dasatinib-related pericardial effusions.