RECURRENT BOSUTINIB-INDUCED PERICARDIAL EFFUSION IN CML

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Abstract

Background Chronic myeloid leukemia (CML) once had a poor prognosis, but the development of tyrosine kinase inhibitors (TKI) have enhanced outcomes and extended life expectancy. Since bosutinibʼs approval in 2012, its cardiac adverse reactions have been described and are quite rare. Case A 72 year-old female with a history of CML presented due to shortness of breath over the past 2 months. An echocardiogram showed a large pericardial effusion without tamponade. Bosutinib was discontinued due to suspicion that it triggered the effusion. Pericardiocentesis was performed with resolution of symptoms, no infection/malignant cells were found. 2 weeks later, repeat imaging showed another large pericardial effusion without tamponade. CT surgery placed a pericardial window and imaging showed reduction of fluid. Decision-making Bosutinib is a TKI shown to increase risk of effusions, most commonly pericardial/pleural with a 13.3% incidence. In 2018, an expert panel published guidelines on managing adverse reactions, but knowledge on such severe cases requiring pericardiocentesis was limited. Little evidence exists on managing extreme reactions, recurrence duration, and essential cardiac assessments before starting bosutinib. Conclusion Awareness of bosutinibʼs cardiac risks needs to be raised. Questions remain, such as should these patients should switch to alternate agents or lower the dosage of bosutinib. More research is needed to understand severe reactions and future options going forward. [Formula presented]

Volume

85

Issue

12

First Page

3980

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