I have a 40 year old female with CML who has been on Imatinib for one year with CMR. Unfortunately, she developed dyspnea recently and an echocardiogram showed a posterior focal pericardial effusion. She was seen by cardiology and started on prednisone and colchicine. I stopped imatinib now and it seems that most TKI have a risk for pericardial effusion. Patient reports she may have had an effusion in the past before starting imatinib but there is no documentation of it. My question is if in this situation you would consider trying pericardiocentesis and biopsy? I am afraid of not being able to resume a TKI in the future. What is the best way to deal with pericardial effusions from imatinib?
This is a tough question. I guess it would depend on what cardiology (and/or rheumatology) have to weigh in if they think this is due to the TKI vs a viral or rheumatologic process or if there is any concern for leukemic involvement. She will almost definitely need a retrial of a TKI as she’s only been in remission for one year. I think trialing Nilotinib would be reasonable as it has less of a risk for effusions compared to dasatinib. Alternatively can retrial imatinib with close serial monitoring with TTE to see if an effusion redevelops.
