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To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML patient cases here. Clinicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("+ NEW TOPIC" button below).

Each clinical case will be forwarded to the iCMLf expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are only accepted from clinicians. If individual patients have a specific question we encourage them to contact their healthcare provider.

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this Forum is solely at your own risk.

TOPIC: Pleural effusion in CML on imatinib

Pleural effusion in CML on imatinib 1 week 6 days ago #1710

  • Dr. Saurabh Bhave
  • Dr. Saurabh Bhave's Avatar
We have a middle aged lady with CML. started on imatinib 400 mg OD since
2 months after starting she had left pleural effusion which required tapping.The examination of the fluid revealed no significant finding. She continued on imatinib and was doing well. She has not achieved MMR at the end of 1 year of treatment.
Recently again she develpoed massive pleural effusion which required tapping.
Repeat examination of the fluid revealed no abnormal finding

1.Dose Imatinib cause pleural effusion: There are some case reports

2.Shall we stop imatinib

Regards

Dr.Saurabh Bhave
M.D. PDF Clinical Haematology
Consultant, Hematology and Bone Marrow Transplant
Tata Medical Center, Kolkata

Pleural effusion in CML on imatinib 1 week 6 days ago #1711

  • Hemant Malhotra
  • Hemant Malhotra's Avatar
Dear Dr. Saurabh,
Thank you for posting this interesting case.
I would suggest that you look for some other cause of the effusion.
Pleural effusions can happen with imatinib (must less common when compared with dasatinib) but are quite rare - occurs in approximately 2% of patients.
Please rule out tuberculosis (not uncommon in India) and collagen vascular disease/connective tissue disorders with appropriate tests.
With regards to Imatinib, as the patient has not achieved a MMR even at 12 months, she should be switched to a second gen, TKI, and with the recurrent effusions, Nilotinib would be the obvious choice.
Hope your patient does well.
Best wishes.
Dr. Hemant Malhotra,

ORIGINAL CASE:
We have a middle aged lady with CML. started on imatinib 400 mg OD since
2 months after starting she had left pleural effusion which required tapping.The examination of the fluid revealed no significant finding. She continued on imatinib and was doing well. She has not achieved MMR at the end of 1 year of treatment.
Recently again she develpoed massive pleural effusion which required tapping.
Repeat examination of the fluid revealed no abnormal finding

1.Dose Imatinib cause pleural effusion: There are some case reports

2.Shall we stop imatinib
Moderators: Melissa Davis-Bishop
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