Dasatinib 50 mg maintains efficacy while reducing pleural effusion and thrombocytopenia in CP-CMLLower Dasatinib Dose May Improve Tolerability for Leukemia Patients

Dasatinib 100 mg once daily is effective for chronic-phase chronic myeloid leukemia (CP-CML), but dose-related toxicity may limit long-term tolerability. We therefore evaluated whether dasatinib 50 mg once daily as an initial dose strategy preserves efficacy while improving safety compared with 100 mg once daily. We performed a systematic review and meta-analysis of adults with CP-CML treated with initial dasatinib 50 mg once daily. MEDLINE via PubMed, Embase, Cochrane CENTRAL, and Web of Science were searched from inception to March 15, 2026. Direct comparative studies of dasatinib 50 mg versus 100 mg were included in the primary analysis; whereas single-arm 50 mg cohorts were summarized as supportive evidence. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Among 613 records identified, 10 reports met eligibility criteria and 7 nonoverlapping analytic reports were retained. Two studies directly compared frontline dasatinib 50 mg versus 100 mg. Twelve-month major molecular response was similar between doses (RR 1.07, 95% CI, 0.92-1.24), while complete cytogenetic response favored 50 mg in unadjusted analysis (RR 1.09, 95% CI, 1.02-1.16). Dasatinib 50 mg reduced pleural effusion (RR 0.20, 95% CI, 0.08-0.50) and thrombocytopenia (RR 0.71, 95% CI, 0.52-0.96). Supportive frontline single-arm data showed pooled 12-month MMR and CCyR proportions of 70.6% and 95.0%, respectively.Overall, initial dasatinib 50 mg once daily may preserve key efficacy outcomes while improving tolerability in CP-CML. Prospective controlled studies are needed.