Dasatinib-induced colitis: clinical, endoscopic and histological findings

Abstract

Background

Dasatinib, a second-generation tyrosine kinase inhibitor, is widely used in patients with haematological malignancies. The main side effects of dasatinib are myelosuppression and pleural effusion; however, colitis, such as haemorrhagic colitis and cytomegalovirus (CMV) colitis, have been reported as rare side effects. There are only a few studies conducted on dasatinib-induced colitis.

Aims

This study aimed to clarify the clinical, endoscopic and pathological features of dasatinib-induced colitis.

Methods

This retrospective study included 51 consecutive patients who received dasatinib therapy between June 2009 and July 2020. Dasatinib-induced colitis was defined as the presence of colitis symptoms, exclusion of other diseases that could cause colitis, and improvement in symptoms after dasatinib withdrawal or dose reduction. CMV positivity was determined based on the positive result of CMV immunostaining.

Results

Dasatinib-induced colitis was diagnosed in nine of 51 patients (17.6%), and most of the symptoms were mild diarrhoea and bloody stools. The endoscopic findings were characterised by loss of vascular pattern (100%) and multiple small erosions (83.3%) which were mainly found in the transverse and descending colon. In a patient who underwent follow-up colonoscopy once a year while taking dasatinib, endoscopic findings changed from initial erythematous spots to multiple erosions, and finally to multiple small round elevations with erosion on the top that disappeared after discontinuation of dasatinib. Anti-CMV therapy was administered to one patient, but the treatment failed. All patients with dasatinib-induced colitis were cured after the discontinuation of dasatinib.

Conclusion

Physicians should consider CMV reactivation to manage dasatinib-induced colitis.

Keywords:

• Dasatinib
• adverse event
• colitis
• cytomegalovirus
• colonoscopy

Acknowledgments

This study was presented in part at the 107th General Meeting of the Japanese Society of Gastroenterology, Tokyo, Japan on 15 April 2021.

Author contributions

KY, IS, KY, KI, ST, MY, ST, SI, and MW collected the data; KY designed and analysed the data; KY, HC and TI drafted the manuscript; MA and MW revised the manuscript for important intellectual content. All authors have read and approved the final version to be published.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.