Dasatinib-Induced T-Cell-Mediated Colitis: A Case Report and Review of the Literature

Area of Science:

• Oncology
• Gastroenterology
• Immunology

Background:

• Dasatinib is a tyrosine kinase inhibitor used for BCR/ABL1-positive malignancies.
• Off-target kinase inhibition and immunomodulating properties of dasatinib are implicated in its side effects.
• Hemorrhagic colitis is a rare but distinct side effect associated with dasatinib therapy.

Purpose of the Study:

• To report a case of dasatinib-induced hemorrhagic colitis in a patient with chronic myelogenous leukemia.
• To investigate the immunological basis of dasatinib-induced colitis through colon biopsies.
• To review existing literature on T-cell mediated colitis caused by dasatinib to identify common patterns and aid management.

Main Methods:

• Case report of a patient with chronic myelogenous leukemia experiencing hemorrhagic colitis during dasatinib treatment.
• Analysis of colon biopsies revealing CD3+CD8+ T cell infiltration.
• Drug discontinuation and rechallenge to assess causality.
• Literature review of dasatinib-induced T-cell mediated colitis cases.

Main Results:

• The patient's colitis resolved upon dasatinib discontinuation and recurred with dose reduction and rechallenge.
• Colon biopsies confirmed significant CD3+CD8+ T cell infiltration.
• Literature review indicated most cases occur after 3 months of exposure and may involve large granular lymphocytes.
• Symptoms uniformly resolve after drug cessation and typically recur upon reintroduction.

Conclusions:

• Dasatinib can induce a T-cell mediated hemorrhagic colitis.
• Diagnosis is supported by biopsy findings and clinical response to drug withdrawal.
• Management involves drug discontinuation and often necessitates alternative therapies, though cautious rechallenge may be possible in select cases.