Doses Of Glucocorticosteroids Research Articles

Rituximab use in patients with ANCA-associated vasculitis: clinical efficacy and impact on immunological parameters.

Rituximab (RTX) was reported effective in ANCA-associated vasculitis (AAV). We aimed to evaluate clinical efficacy of RTX in AAV along with its impact on immunological parameters. Eighteen RTX-treated AAV patients (M/F 11/7; median age 37.5; 15× PR3-ANCA, 3× MPO-ANCA; 16× relapsing/refractory, 2× first-line therapy) were enrolled. Clinical response, ANCA, total serum IgG levels and cellular immunity parameters were examined. The patients were followed up (FU) for a median of 26months (range 3-82, 15 for ≥6months). All patients achieved B cell depletion (lasting 3-24months). No significant increase was noted in T cell or NK cell subpopulations. At 6months, partial remission was achieved in 5/15 patients (33%) and complete in 8 (53%). The median prednisone dose (30..10mg/d) and ANCA levels (17.2..2.7IU/mL) decreased (p < 0.01). RTX retreatment was used in nine (8× pre-emptive, 1× relapse). Six patients relapsed (none of the pre-emptively treated). Three patients died of infection. IgG levels at 3months decreased compared to baseline (9.0 vs 5.7g/L, p < 0.01). Higher percentage of HLA-DR+CD3+ cells and lower percentage of CD4+CD45RA+ naive T cells persisted during FU. IFN-γ production increased at 6months compared to baseline (27.3 vs 41.5%). No significant change was noted in the intracellular IL-10 and IL-12 production. RTX helped to lower the glucocorticosteroids dose and withdraw cytotoxic drugs in most AAV patients. Hypogammaglobulinaemia was common but well tolerated. Peripheral circulating T cells remained activated despite B cell depletion.

Current methods of treatment of true acantholytic pemphigus

Major stages of the pathogenesis of true acantholytic pemphigus are interpreted in terms of autoimmune pathology; therefore, treatment of this group of diseases remains pathogenetic and is aimed at suppressing the synthesis of autoantibodies against keratinocyte proteins. Treatment with the use of systemic glucocorticosteroids is currently the main method of treatment for true acantholytic pemphigus. To reduce the course dose of glucocorticosteroids, decrease the risk of adverse effect development and achieve long-term remission, further studies of disease pathogenesis and development of new treatment methods for reducing the doses of glucocorticosteroids are of great importance.

SP0189 Induction of Remission by Low-Dose IL-2-Therapy in One SLE Patient with Increased Disease Activity Refractory to Standard Therapies

IL-2 deficiency and associated regulatory T cell (Treg) defects critically contribute to SLE pathogenesis. In our previous translational work we proved the efficacy and safety of a low-dose IL-2 therapy...

AB0350 Prospective Observational Study in Rheumatoid Arthritis Adults in Russia: Osteoporosis, Sarcopenia, Falls and Fractures

BackgroundOsteoporosis (OP) and falls lead to fractures especially in patients with rheumatoid arthritis (RA) due to pain and joint abnormalities, low muscle mass and strength, functional impairment, that have consequences...

SAT0137 Effect of Rheumatoid Arthritis Activity in First Trimester of Pregnancy on the Disease during Gestation and Postpartum

BackgroundKnown that pregnancy in 66-91% of patients (pts) with rheumatoid arthritis (RA) contributes to improve health and reduce disease activity during gestation. The remaining 9-34% activity dynamics not observed or...

Therapeutic Plasma Exchange in Glucocorticosteroid‐Unresponsive Patients With Clinically Isolated Syndrome

Clinically Isolated Syndromes (CIS) summarize clinical features of possible multiple sclerosis (MS) as a first clinical event of the disease. Escalation therapy in CIS episodes comprises high dose glucocorticosteroid (GCS) treatment followed by therapeutic plasma exchange (TPE) in patients unresponsive to GCS. The aim of our study was to analyze TPE effects in CIS patients. Eleven GCS-unresponsive patients exhibiting CIS were treated with TPE. A median of 5.0 (range 3-8) treatments were performed with a median exchange volume of 3.0 L (range 2.2-3.5 L). Standard diagnostic results in CIS patients were collected. In 10 out of 11 patients clinical improvement was observed. In Expanded Disability Status Scale (EDSS) Scoring, a commonly used score to assess disability in MS and CIS patients, significant improvement was shown as well. One patient was a non-responder to TPE. Apheresis treatments were well tolerated in all patients. In the medical control of GCS-unresponsive CIS episodes, TPE appears to be an effective and well-tolerated treatment option. TPE response in CIS patients is comparable to TPE results in GCS-unresponsive MS relapses. Further prospective studies are indicated.

P70 ‐ Testing adherence to asthma clinical guidelines in Spain

Results A total of ninety-nine surveys were submitted. Distribution of the pediatricians who answered was as follow: 15% ER, 14% inpatient ward, 10% subspecialties, 6% neonatology, 41% general pediatrics, and 13% were residents. On a clinical scenario of an asthma exacerbation, 71,8% pediatricians correctly identified the severity of the exacerbation as moderate using the pulmonary score, and 86,2% would start an oral glucocorticosteroids treatment plus inhaled rapid-acting b2 agonists at adequate doses. Moreover, up to 48,9% would start a controller treatment. However, only 89,2% of them would use an adequate inhaled glucocorticosteroids dose and for an adequate period of time. There were no significant differences in the population surveyed answers, although their experience and working environment were not homogeneous. Conclusions Severity scores are not widespread in our region, although this fact does not affect the assessment and correct treatment of exacerbations. There is a positive trend towards starting a controller treatment from the ER consultation. The adherence to the current asthma evidence-based clinical guidelines is insufficient. It is important to perform periodical revisions of the adherence to the guidelines in order to detect our flaws and to improve our clinical performance.

A3.11 Induction of remission by low-dose IL-2-therapy in one SLE patient with increased disease activity refractory to standard therapies: A case report

IL-2 deficiency and associated regulatory T cell (Treg) defects contribute essentially to SLE pathogenesis. In our previous translational work we proved the efficacy and safety of a low-dose IL-2 therapy...

Trudności diagnostyczne u pacjentki z włóknieniem płuc i zwapnieniami w tkankach miękkich: scleromyositis

Choroby tkanki łącznej, a zwłaszcza zespoły nakładania, ze względu na znaczną różnorodność i zmienność objawów klinicznych mogą być powodem trudności diagnostycznych. W pracy przedstawiono przypadek 57-letniej kobiety z włóknieniem płuc, dolegliwościami bólowymi stawów rąk oraz zwapnieniami w tkankach miękkich. Włóknienie płuc oraz obecność zmian naczyniowych w badaniu kapilaroskopowym, przy braku typowych skórnych cech twardziny układowej, sugerowały rozpoznanie zespołu twardzinopodobnego. Pół roku od pierwszej hospitalizacji u chorej stwierdzono podwyższenie aktywności kinazy kreatynowej w surowicy, z towarzyszącymi objawami uszkodzenia pierwotnie mięśniowego w badaniu elektromiograficznym. Zajęcie układu mięśniowego uznano za objaw zespołu określanego jako scleromyositis, w którym często występują zwapnienia w tkankach miękkich. Rozpoznanie potwierdzono badaniem histopatologicznym wycinka skórno-mięśniowego. Wczesne wystąpienie zwapnień mogło być spowodowane niedoborem witaminy D i wtórną nadczynnością przytarczyc. W leczeniu chorej zastosowano z powodzeniem małe dawki glikokortykosteroidów, azatioprynę i suplementację witaminą D.

A Randomized Trial Of Daily Prednisone Versus Pulsed Dexamethasone In Treatment Naïve Patients With Idiopathic Thrombocytopenic Purpura

▪ IntroductionDaily prednisone is considered standard first line therapy in idiopathic thrombocytopenic purpura (ITP). Since its long-term efficacy is limited, other glucocorticosteroids and schedules have also been tested. The most widely used regimen is pulsed dexamethasone. We performed a randomized, prospective, multicentre trial to analyze the efficacy of daily prednisone versus pulsed dexamethasone as first line treatment of ITP. Patients and methodsDiagnosis was made and requirement for treatment defined as outlined in the 1996 practice guidelines of the American Society of Hematology (Blood 88:3, 1996). The primary endpoint was remission duration, remission being defined as any platelet count above 50x109/l. Sample size calculation was based on the assumption that 60 % of patients receiving daily prednisone and 90 % of patients receiving pulsed dexamethasone would achieve a remission. To detect an increase in the percentage of responding patients maintaining remission for at least 6 months from 35 % to 70 % at a significance level of 5 % with a power of 80 %, 22 patients had to be included in each treatment arm. The trial was approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen, Germany (no. 02-1900; May 13, 2002) and registered with and approved by the Federal Institute for Drugs and Medical Devices, Bonn, Germany (BfArM no. 4019209; July 22, 2002). Treatment schedulesDuring the first week of treatment all patients received prednisone (1 mg/kg/d) followed by a 1:1 randomization between daily prednisone and pulsed dexamethasone. In the prednisone arm prednisone was given at 1 mg/kg/d for another week. In case of remission the dose was gradually tapered over a course of 19 weeks to reach a maintenance dose not exceeding 25 mg/d at the end of week 13 and below 7.5 mg/d at the end of week 19. If remission was not achieved after a total of two weeks of daily prednisone at 1 mg/kg, the dose was increased to 2 mg/kg/d for another 2 weeks. In case of remission the dose was subsequently reduced as described above. Patients randomized to the dexamethasone arm were treated with 6 courses of pulsed dexamethasone (0.6 mg/kg day 1 to 4) at 3-week intervals. In case of failure to achieve a remission patients crossed over to the alternative treatment arm (prednisone: no remission after 4 weeks of prednisone at 1-2 mg/kg/d, maintenance dose above 25 mg/d at the end of week 13 or above 7.5 mg/d at the end of week 19; dexamethasone arm: no remission after two cycles). ResultsRecruitment was stopped before reaching the target patient number because of slow accrual and an inability to extend the study subject insurance. Between 2002 and 2010 26 patients were enrolled. Twelve patients were randomized to prednisone, 14 to dexamethasone and 4 were subsequently excluded because of protocol violations (3 in the prednisone and 1 in the dexamethasone arm). The median age in the 22 evaluable patients was 45 years (range 22 – 77), 13 were male, 18 had primary and 4 had secondary ITP. All patients achieved a remission. There was no statistically significant difference in the interval between treatment initiation and achievement of remission (p=0.55). Remission duration, however, was significantly longer in the dexamethasone as compared to the prednisone arm (p=0.0139; Figure 1). Median treatment duration in the prednisone arm was 85 days (range: 28 – 153), and median number of treatment cycles in the dexamethasone arm was 5 (range: 3 – 7). During the treatment the median cumulative cortisol equivalent dose was 15.780 mg in the prednisone and 34.560 mg in the dexamethasone arm. Grade 3 or 4 bleeding events during treatment were limited to petechiae (prednisone: 1 patient; dexamethasone: 2 patients). Grade 3 or 4 adverse events were recorded in 1 patient in the prednisone arm (hypertension) and 2 patients in the dexamethasone arm (hyperglycemia, hypokalemia). [Display omitted] ConclusionsIn this randomized trial sequential cycles of pulsed dexamethasone proved more effective than continuous daily prednisone in inducing stable remission in treatment naïve patients with ITP. This correlated with a higher cumulative glucocorticosteroid dose. We hypothesize that the intensity of immunosuppression is an important determinant of treatment outcome. Disclosures:No relevant conflicts of interest to declare.

Factors that determine body composition of female systemic lupus erythematosus (SLE) patients in Sri Lanka: a comparative study using dual-energy x-ray absorptiometry

Studies on body composition and its determinants among SLE patients are limited. Estimation of body composition, analysis of determinants and associations of different body compartments are important in planning long-term care of these patients. The aim of the study was to identify the changes in body composition among SLE patients and assess the effect of corticosteroid use, patient and disease-related variables on body composition. We compared lean mass, fat mass, bone mineral density (BMD), and bone mineral content (BMC) determined by dual-energy x-ray absorptiometry technology, in a group of premenopausal women with SLE (n = 27) and an age-matched healthy group of women (n = 27). The median (IQR) duration of SLE was 3 (2-5) years while median (IQR) duration and dose of prednisolone therapy were 108 (88 - 172) weeks and 9730 (6160-15360) mg, respectively. No significant difference was observed in body mass index (BMI) or total fat mass between the two groups. SLE patients, however, had significantly lower lean mass (p < 0.001), BMD (p < 0.001) and BMC (p < 0.005) than healthy controls. Among cases, compared with lean mass, total body fat content showed stronger associations with total body BMD (r = 0.49, p < 0.01) and total body BMC (r = 0.63, p < 0.01). When a stepwise regression model was fitted, lean mass among controls and total fat mass among cases emerged as the best predictors of BMC/BMD. No significant correlations were found between the disease duration or cumulative glucocorticosteroid dose and total body BMD, total body BMC, lean mass or total fat content in SLE patients.

An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis

Introduction: Intra-lesional glucocorticosteroid (GCS) injections are used widely for painful musculoskeletal conditions in general practice.Case: A 26 year old female, was given an intra-lesional injection of 24 mg methyl prednisolone acetate (MPA) with 15 mg lidocaine for treatment of DeQuervain's tenosynovitis. She was six weeks postpartum and predominantly breast feeding. Lactation was suppressed at approximately 30 h post injection and this persisted for a period of approximately 36 h before spontaneous resumption of milk production. Lactation returned to normal 90 h after the injection.Discussion: Studies done in lactating animals have shown that injected GCS have led to a reduction of milk production, but there is limited data on these injections in lactating humans. The dose of GCS administered and the site of the GCS injection appear to contribute to this phenomenon. Very large doses of GCS have caused suppression of lactation in humans as opposed to low doses of GCS. Injections of GCS into areas of the body subjected to high activity level like the knee or wrist could lead to greater systemic absorption of GCS than GSC administered to body sites with lower physical activity like the shoulder.Conclusion: Local injection of MPA reversibly suppressed lactation in a young woman for a period of 24–48 h. Doctors using injectable GCS in lactating women should apprise patients of this possibility. Mothers can take precautions like expressing and storing enough breast milk to cover this period prior to receiving these injections.

SAT0065 Prospective 1-Year Study of Falls and Fractures in Patients with Rheumatoid Arthritis

BackgroundPatients with rheumatoid arthritis (RA) have impaired levels of physical activity and postural stability, so we can suggest that they have increased risk of falls. RA-patients also have a higher...

FRI0459 Impact of ergometric test in patients with rheumatoid arthritis, ankylosing spondylitis and systemic lupus erythematosus, without cardiovascular symptoms, before starting a supervised physical activity program

BackgroundCardiovascular (CV) diseases are the most relevant causes of mortality in patients with autoimmune rheumatic diseases (AIRD), including rheumatoid arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE). Supervised...

SAT0502 Combined Clinical, Laboratory and Magnetic Resonance Imaging (MRI) Evaluation of Response to Anti-TNF Agents in Large Vessel Vasculitis (LVV)

BackgroundTreatment of LVV remains challenging. Patients usually respond to glucocorticosteroids (GC) therapy, but often relapse on tapering of the GC dose or after GC withdrawal. Anti-TNF agents represent an alternative...

CD4+Foxp3+ regulatory T cells prolong drug-induced disease remission in (NZBxNZW) F1 lupus mice

IntroductionThe ability to ameliorate murine lupus renders regulatory T cells (Treg) a promising tool for the treatment of systemic lupus erythematosus (SLE). In consideration to the clinical translation of a Treg-based immunotherapy of SLE, we explored the potential of CD4+Foxp3+ Treg to maintain disease remission after induction of remission with an established cyclophosphamide (CTX) regimen in lupus-prone (NZBxNZW) F1 mice. As a prerequisite for this combined therapy, we also investigated the impact of CTX on the biology of endogenous Treg and conventional CD4+ T cells (Tcon).MethodsRemission of disease was induced in diseased (NZBxNZW) F1 mice with an established CTX regimen consisting of a single dose of glucocorticosteroids followed by five day course with daily injections of CTX. Five days after the last CTX injection, differing amounts of purified CD4+Foxp3+CD25+ Treg were adoptively transferred and clinical parameters, autoantibody titers, the survival and changes in peripheral blood lymphocyte subsets were determined at different time points during the study. The influence of CTX on the numbers, frequencies and proliferation of endogenous Treg and Tcon was analyzed in lymphoid organs by flow cytometry.ResultsApart from abrogating the proliferation of Tcon, we found that treatment with CTX induced also a significant inhibition of Treg proliferation and a decline in Treg numbers in lymphoid organs. Additional adoptive transfer of 1.5 × 106 purified Treg after the CTX regimen significantly increased the survival and prolonged the interval of remission by approximately five weeks compared to mice that received only the CTX regimen. The additional clinical amelioration was associated with an increase in the Treg frequency in the peripheral blood indicating a compensation of CTX-induced Treg deficiency by the Treg transfer.ConclusionsTreg were capable to prolong the interval of remission induced by conventional cytostatic drugs. This study provides valuable information and a first proof-of-concept for the feasibility of a Treg-based immunotherapy in the maintenance of disease remission in SLE.

A case report of non-islet cell tumour hypoglycaemia associated with ovarian germ-cell tumour

Background: Non-islet cell tumour hypoglycaemia is a rare paraneoplastic condition in which tumours secrete a high-molecular-weight precursor of insulin-like growth factor-II causing hypoglycaemia and can be difficult to identify and treat. Case Presentation: This is the case of a 27-year-old patient from Africa with metastatic ovarian yolk sac tumour who presented with hypoglycaemia and was subsequently diagnosed with non-islet cell tumour hypoglycaemia. Case Management: Our patient required higher doses of glucocorticosteroids than reported in the literature in combination with recombinant growth hormone therapy in order to control her hypoglycaemia. Case Outcome: This is the first case of non-islet cell tumour hypoglycaemia described in association with a germ-cell tumour. Her management required collaboration between the endocrinology team, the palliative care team, the acute medicine team and physicians in Africa to enable her safe journey home. Conclusions: This case illustrates the need for awareness among general physicians of rare tumour manifestations and the need for multidisciplinary input for the optimal management of these patients.

Response to immunotherapy in CLIPPERS syndrome

Dear Sirs,Chronic lymphocytic inflammation with pontine perivas-cular enhancement responsive to steroids (CLIPPERS) is arecently described treatable, brainstem-predominant, clin-ical and radiological entity [1]. Patients with this conditionpresent with an episodic brainstem syndrome and showcharacteristic scattered and punctate gadolinium (Gd)enhancement in the pons and adjacent CNS structures.They prototypically respond to high dose glucocorticos-teroids and may require chronic steroid or immunosup-pressive treatment, although the effect of intravenousimmunoglobulins (IVIG) in this disease is unknown. Herewe report a patient with CLIPPERS that experienced aclinical rebound of the disease after a short pulse of IVIG.A 28-year-old woman with subacute gait ataxia anddiplopia was admitted to the hospital. Neurologicalexamination revealed internuclear ophthalmoplegia, hori-zontal bidirectional nystagmus and gait and four-limbataxia. Brain and spinal MRI showed multiple punctate Gdenhancing lesions in the mesencephalon, cerebellum andcervical spinal cord. The patient was tested for the presenceof systemic auto-antibodies, anti-neuronal antibodies,infectious pathogens (HIV, T. Pallidum, Brucella spp., B.burgdorferi) and tumoral serum biomarkers. CSF analysisincluded standard biochemistry, cytology and bacteriolog-ical cultures, oligoclonal bands and tests for Tropherymawhippelii and Herpesviridae, with no significant findingsexcept for mildly raised CSF protein. Body-CT and bodyand brain PET-CT were also normal. The patient wastreated with intravenous methylprednisolone for 3 days(1 g/day) followed by oral prednisone tapering startingfrom a dose of 60 mg/day. One week after starting meth-ylprednisolone, she had completely recovered and wascontinued on a slow reduction of oral steroid dose. How-ever, any attempt to taper the oral steroid dose below12.5 mg/day led to neurological relapse of the symptomsand, therefore this dose was maintained for the next6 months. After this period (1 year after disease onset), shewas asymptomatic and physical examination was normal,and therefore treatment discontinuation was reassessed.After she stopped steroids for a few days she suffered arebound of her symptoms: she had new onset mild gaitataxia and brisk symmetric ankle- and knee-jerks. Newbrain and spinal cord MRI disclosed multiple scatteredpunctuate and non-confluent enhancing lesions of a maxi-mum diameter of 0.7 cm visible mainly in the white matterof both cerebellar hemispheres, cerebellar peduncles and inthe cervical spinal cord. (Fig. 1a). At that moment, pontineGd enhancement was relatively scarce compared with thecerebellar hemispheres. Additionally, mild but appreciableamount of diffuse Gd peppering was visible in the whitematter of the whole brain adjacent to the cortico-subcor-tical border. Prednisone dose was increased to 30 mg/dayand the patient recovered to normal in 3 days. Thereafter, a12.5 mg/day dose was maintained for the following9 months and the patient remained asymptomatic. A newMRI 3 months after restoration of steroid therapy showedclear improvement of Gd lesions (Fig. 1b). Notwithstand-ing, steroid side-effects became evident with amenorrhea,hirsutism, mild weight gain and acne. Any attempt to tapersteroid dose below 10 mg/day resulted in a blooming ofneurological symptoms. After assuring 2 weeks of clinicalstability, a short attack pulse of intravenous immunoglob-ulins (IVIG) was administered (0.4 g/kg/day for 5 days)

Prevalence of osteoporosis and osteopenia in advanced chronic obstructive pulmonary disease patients

Background:Reduction of bone mineral density (BMD) is a known and established phenomenon in chronic obstructive pulmonary disease (COPD). However, there have been no data regarding osteoporosis/osteopenia in COPD patients in India.Aim:To look for the degree and frequency of osteoporosis/osteopenia in our OPD patients being diagnosed as COPD.Materials and Methods:Thirty-seven randomly selected patients with COPD were assessed for BMD with commercially available ultrasound bone densitometer (HOLOGIC SAHARA) in a pulmonary OPD. Some cofactors for reduced BMD were also noted.Results:Out of the 37 COPD (all belonging to the GOLD III/IV category) patients studied, the BMD was found to be normal in 10 (27%) patients, while 27 (73%) patients were found to have osteopenia/osteoporosis [19 (51.35%) and 8 (21.62%) patients having osteopenia and osteoporosis, respectively].Conclusion:Frequency of osteoporosis and osteopenia was found to be very high (73%) in our population of advanced COPD. The data suggest a need for further in-depth study regarding the issue.

Extensive Pleural and Pericardial Effusion In 4 CML Patients Treated with Dasatinib at 100 Mg or 50 Mg Once Daily.

AbstractAbstract 4496The multikinase BCR/ABL inhibitor dasatinib exerts major growth-inhibitory effects in imatinib-resistant patients with chronic myeloid leukemia (CML). Although previously reported to be a well-tolerated drug, several side effects such as pleural and pericardial effusion have been reported at a dose of 140 mg daily. Therefore, the approved standard dose of dasatinib was reduced to 100 mg daily. More recent data suggest that freshly diagnosed patients with CML treated with dasatinib at 100 mg once daily may still develop pleural effusions, but the frequency of this side effect was reported to be lower compared to patients receiving 140 mg daily dasatinib. Moreover, effusion formation was reported to be less severe, with almost no grade 3/4 events, in patients receiving 100 mg daily dasatinib. We examined a cohort of CML patients (n=13) treated with dasatinib at 100 mg or 50 mg daily, for development of severe non-hematologic side effects. Patients received dasatinib for at least 3 months (range: 3–38 months; observation period: March 2005 to June 2010). Of these 13 patients, 4 had previously received 140 mg dasatinib daily. In all 4 patients, the dose of dasatinib was reduced to 100 mg or 50 mg daily because of effusion formation. In the other 9 patients, the initial dose of dasatinib was 100 mg daily. Of these 9 patients, 2 patients in chronic phase (CP) received dasatinib as frontline therapy. Four of our 13 patients developed severe effusions (grade 3/4) while on dasatinib at 100 mg or 50 mg daily, including one CP patient receiving dasatinib as frontline therapy. In two patients, massive pleural effusions were recorded, and two developed pericardial effusion together with pleural effusions. In two patients, effusion formation required paracentesis and surgical intervention. No pre-existing cardiac or pulmonary diseases were known in these 4 patients. In 3 patients, dasatinib had to be discontinued despite treatment with low dose glucocorticosteroids and diuretics. After switching to an alternative BCR/ABL inhibitor, no further effusion formation occurred. In summary, dasatinib-treated patients are at risk for the development of pleural and pericardial effusions even when the drug is administered at a dose of 100 mg or 50 mg daily. Therefore, all patients should be examined carefully for pre-existing relevant comorbidities and cardiovascular risk factors before dasatinib is started, and all patients should have repeated chest × ray controls during long-term treatment with dasatinib. Disclosures:Valent:Novartis: Honoraria, Research Funding; BMS: Honoraria, Research Funding.