Reversible Dasatinib-Associated Pulmonary Hypertension Managed With Dual Therapy and Hemodynamic-Guided Withdrawal

Dasatinib is a recognized cause of drug-induced pulmonary arterial hypertension (PAH), which may occasionally present with severe hemodynamic compromise. Evidence regarding optimal management and safe withdrawal of targeted therapy after recovery remains limited.

A 41-year-old woman with chronic myeloid leukemia treated with dasatinib presented with rapidly progressive dyspnea and right heart failure, requiring intensive care admission due to cardiac tamponade. Right heart catheterization confirmed high-risk precapillary PAH (mean pulmonary artery pressure: 40 mm Hg; pulmonary vascular resistance: 8 Wood units). Dasatinib was permanently discontinued, and initial dual oral PAH therapy with macitentan and tadalafil was started, leading to rapid clinical, functional, and echocardiographic improvement. Hemodynamic reassessment demonstrated complete normalization, allowing sequential withdrawal of pulmonary vasodilator therapy under close follow-up. The patient remained asymptomatic with a sustained low-risk profile after complete treatment discontinuation.

This case highlights the potential reversibility of dasatinib-associated PAH and the role of invasive reassessment to guide safe therapy de-escalation.

Dasatinib-associated PAH can be fully reversible, and hemodynamic-guided withdrawal of therapy may be feasible in selected patients.