Ponatinib-induced pneumonitis with severe acute respiratory distress syndrome
  • Sofia Dinis Ferreira
    Serviço de Medicina Intensiva, Hospital Dr. Nélio Mendonça, Funchal, Portugal
  • Margarida Jardim
    Serviço de Medicina Intensiva, Hospital Dr. Nélio Mendonça, Funchal, Portugal
  • Margarida Câmara
    Serviço de Medicina Intensiva, Hospital Dr. Nélio Mendonça, Funchal, Portugal
  • Fernando Jacinto
    Serviço de Hematologia, Hospital Dr. Nélio Mendonça, Funchal, Portugal
  • Fernando Aveiro
    Serviço de Hematologia, Hospital Dr. Nélio Mendonça, Funchal, Portugal
  • José Júlio Nóbrega
    Serviço de Medicina Intensiva, Hospital Dr. Nélio Mendonça, Funchal, Portugal

Keywords

Ponatinib, acute lymphoblastic leukaemia, Philadelphia chromosome-positive, ARDS, pneumonitis

Abstract

Ponatinib is a third-generation tyrosine kinase inhibitor (TKI) that can effectively treat patients with acute lymphoblastic leukaemia (ALL), particularly those with Philadelphia chromosome-positive (Ph+ALL) subtype, who are resistant or have previously received other TKIs.
We report a case of a 42-year-old female with Ph+ALL who was admitted to the intensive care unit with respiratory failure and severe acute respiratory distress syndrome (ARDS), while on treatment with ponatinib. Despite being treated with multiple antibiotics and antivirals, the patient’s condition continued to worsen, and pulmonary complications secondary to TKI were suspected. After starting a steroid regimen, the patient’s condition improved drastically with resolution of the pulmonary complications.
While many adverse events (AEs) happen in the beginning stages of TKI treatment, certain toxicities may not arise until months after therapy initiation. Cardiovascular complications are the most common AE of ponatinib, including heart failure and arterial hypertension. Pulmonary complications may occur, and management includes drug cessation and individualised steroid therapy.
In case of respiratory failure without signs of infection and no improvement with antimicrobial treatment, clinicians should consider the possibility of pulmonary toxicity associated with ponatinib.

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References

  • Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer Jl 2017;7:e577.
  • Massaro F, Molica M, Breccia M. Ponatinib: a review of efficacy and safety. Curr Cancer Drug Targets 2018;18:847–856.
  • Weatherald J, Bondeelle L, Chaumais M-C, Guignabert C, Savale L, Jais X, et al. Pulmonary complications of Bcr-Abl tyrosine kinase inhibitors. Eur Respir J 2020;56:2000279.
  • Cortes JE, Kantarjian H, Shah NP, Bixby D, Mauro MJ, Flinn I, et al. Ponatinib in refractory Philadelphia chromosome-positive leukemias. N Engl J Med 2012;367: 2075–2088.
  • Cortes JE, Kim D-W, Pinilla-Ibarz J, le Coutre PD, Paquette R, Chuah C, et al. Ponatinib efficacy and safety in Philadelphia chromosome-positive leukemia: final 5-year results of the phase 2 PACE trial. Blood 2018;132:393–404.
  • Medeiros BC, Possick J, Fradley M. Cardiovascular, pulmonary, and metabolic toxicities complicating tyrosine kinase inhibitor therapy in chronic myeloid leukemia: strategies for monitoring, detecting, and managing. Blood Rev 2018;32: 289–299.
  • Bergeron A, Rea D, Levy V, Picard C, Meignin V, Tamburini J, et al. Lung abnormalities after dasatinib treatment for chronic myeloid leukemia: a case series. Am J Respir Crit Care Med 2007;176:814–818.
  • Abouzid M, Raru Y, Elbeshina A, Aljasmi M. Ponatinib-induced pneumonitis: a first case report. Chest 2022;162:Suppl. A704.
  • Peerzada MM, Spiro TP, Daw HA. Pulmonary toxicities of tyrosine kinase inhibitors. Clin Adv Hematol Oncol 2011;9:824–836.
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    Published: 2023-11-13
    Issue: 2023: Vol 10 No 12 (view)


    How to cite:
    1.
    Ferreira SD, Jardim M, Câmara M, Jacinto F, Aveiro F, Nóbrega JJ. Ponatinib-induced pneumonitis with severe acute respiratory distress syndrome. EJCRIM 2023;10 doi:10.12890/2023_004162.

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