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Severe pleural effusion associated with nilotinib for chronic myeloid leukaemia: cross-intolerance with tyrosine kinase inhibitors
  1. Kasumi Satoh1,
  2. Saori Morisawa2,
  3. Manabu Okuyama1 and
  4. Hajime Nakae1
  1. 1 Advanced Emergency and Critical Care Center, Akita University Hospital, Akita, Japan
  2. 2 Department of Pharmacy, Akita University Hospital, Akita, Japan
  1. Correspondence to Dr Kasumi Satoh; satohkasumi19900114{at}


Nilotinib is used as standard treatment in managing chronic myeloid leukaemia (CML). A 23-year-old man with CML and on nilotinib was admitted to the intensive care unit due to respiratory failure. Three years prior, he developed pleural effusion from dasatinib therapy thus, his CML regimen was changed to nilotinib. Although the pleural effusion had once improved, the chest imaging revealed left-dominant bilateral pleural effusion. Endotracheal intubation and left thoracic drainage were performed. Nilotinib treatment was discontinued, and approximately 60 hours later, nilotinib concentrations of 927 and 2092 ng/mL were determined in his blood and pleural effusion, respectively. Severe pleural effusion may be induced in patients administering nilotinib, and nilotinib concentrations in blood and pleural effusion can be elevated in patients with nilotinib-related pleural effusion. Cross-occurrence of pleural effusions needs to be monitored precisely, especially in patients who are switched to other tyrosine kinase inhibitors after dasatinib treatment.

  • haematology (drugs and medicines)
  • emergency medicine
  • intensive care
  • respiratory medicine

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  • Contributors KS designed the case report and wrote the initial draft of the manuscript. SM supervised the pharmacological data and contributed to the preparation of the manuscript. MO contributed to data collection and interpretation and critically reviewed the manuscript. HN contributed to the conception of the case report and critically revised the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.