Purpose: Dasatinib is a tyrosine kinase inhibitor indicated for the treatment of chronic myeloid leukemia (CML). In October 2013, reversible lymph node follicular hyperplasia associated with dasatinib was first reported. The purpose of this case report is to describe a reactive lymphoid process with follicular and interfollicular hyperplasia associated with dasatinib treatment.
Methods: This is a case report of a white male, aged 37 years, receiving oral dasatinib 100 mg once daily for chronic phase CML for 8 months following failure of imatinib and intolerance to nilotinib. A Pubmed literature review revealed only 1 other report of 9 cases developing cervical lymphadenopathy after a median of 20 months on dasatinib (range 9 to 35 months).
Results: Following 8 months of dasatinib therapy, the patient presented with facial swelling on his right jaw and right cheek bone. A CT scan revealed multiple mildly enlarged lymph nodes within the parotid gland and right level II nodal stations without any definite mucosal lesions seen. On physical exam, he was found to have a 1.5-cm right parotid nontender mass and a 3-cm right level II nontender nodular mass with no overlying erythema or edema. He failed a trial of antibiotics with amoxicillin 875 mg/clavulanate 125 mg for 10 days. Fine needle aspiration of both the right parotid mass and the right nodular mass revealed reactive lymphoid cells. An excisional biopsy of the right parotid mass with flow cytometry demonstrated fragmented benign lymphoid tissue with reactive follicles and expansion of the interfollicular region with no evidence of leukemic involvement. He then underwent right parotidectomy due to progressive swelling and discomfort. Pathology review was consistent with reactive lymphoid process with florid follicular and interfollicular hyperplasia. There was again no evidence of lymphoid or lymphomatous involvement. Dasatinib therapy was subsequently discontinued and resolution of follicular hyperplasia occurred within 1 month.
Conclusions: Follicular hyperplasia is a rare adverse effect associated with the use of dasatinib. Our patient presented much earlier (within 8 months of dasatinib therapy) than previously reported cases. Patients on dasatinib experiencing cervical or other lymph node enlargement should be evaluated for follicular hyperplasia. It is recommended that dasatinib be discontinued in the presence of follicular lymphoid hyperplasia; however, use of another tyrosine kinase inhibitor should be considered. Our patient was subsequently switched to bosutinib.
