Multidisciplinary Rehabilitation for Severe Respiratory Failure Due to Dasatinib-Induced Pulmonary Toxicity: A Case...

BACKGROUND Tyrosine kinase inhibitors (TKIs) are effective for chronic myeloid leukemia (CML), but they may cause pulmonary toxicity, including pleural effusion. In severe cases, respiratory failure requiring mechanical ventilation can occur, and weaning from the ventilator may be difficult. Although multidisciplinary rehabilitation strategy may be necessary for favorable outcomes and physical function in such situations, it has not been well described. CASE REPORT A 73-year-old woman with CML was responding well to TKI treatment, but prolonged pleural effusion as an adverse effect led to home oxygen therapy 9 years after diagnosis. She was admitted with acute type II respiratory failure (pH: 7.076, PaO2: 181.1 mmHg, and PaCO2: 213.3 mmHg) triggered by pneumonia and required intubation and mechanical ventilation. Rehabilitation began the day after admission and advanced progressively. Extubation was considered impossible due to persistent hypercapnia, so a tracheostomy was performed on day 11. A structured multidisciplinary rehabilitation program was continued throughout the acute and recovery phases. Her physical function gradually improved, although without complete ventilator weaning. She regained independent ambulation and achieved a Barthel index score of 100. Daytime ventilator support was discontinued, while nocturnal ventilation was maintained. After caregiver training and coordinated discharge planning, she was discharged home on hospital day 105 with nighttime mechanical ventilation. CONCLUSIONS Early and coordinated multidisciplinary rehabilitation can facilitate functional independence and home discharge, even when complete ventilator weaning is impossible, in patients with cancer treatment-related pulmonary toxicity. Collaboration across specialties may be essential in managing complex cases of prolonged respiratory failure.