Large granular lymphocytosis during dasatinib therapy

Abstract

Dasatinib is a second generation tyrosine kinase inhibitor (TKI) approved for clinical use in patients with imatinib-resistant chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL). Large granular lymphocytes (LGLs) are medium to large cells with eccentric nuclei and abundant cytoplasm with coarse azurophilic granules. LGL lymphocytosis is caused by a proliferation of cytotoxic (CD8⁺) T cells and/or NK cells. In a proportion of CML and Ph⁺ ALL patients, there is a significant expansion of LGLs during dasatinib therapy. LGL lymphocytosis is seen in some cases with fevers, colitis, and pleural effusions (PE), suggesting an aberrant immune response mediated by these LGLs. LGLs may participate in the elimination of the residual leukemic cells, and LGL clonal expansion is associated with excellent, long-lasting therapy responses in dasatinib-treated patients. For a more comprehensive analysis, we analyzed the morphologic, phenotypic, clinical, and functional features of the LGL subsets amplified in vivo during dasatinib therapy.

Keywords: :

• large granular lymphocyte
• tyrosine kinase inhibitor
• dasatinib
• pleural effusion
• response

10.4161/cbt.27310

Disclosure of Potential Conflicts of Interest

No potential conflict of interest was disclosed.

Acknowledgments

This study was supported by National Natural Science Foundation of China (30871104, 30971296, 81170485, 81170488, 81370657), Natural Science Foundation of Jiangsu Province (BK2010584), Key Projects of Health Department of Jiangsu Province (K201108), Jiangsu Province’s Medical Elite Program (RC2011169), National Public Health Grand Research Foundation (201202017), Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institute (JX10231801), Program for Development of Innovative Research Teams in the First Affiliated Hospital of Nanjing Medical University, and Project of National Key Clinical Specialty.

Authors’ Contributions

All authors contributed to initial drafts, edited versions, and the final version. All authors read and approved the final manuscript.