Management of tyrosine kinase inhibitors adverse effects in patients with chronic myelogenous leukemia

Abstract

Introduction of tyrosine kinase inhibitors (TKI) to the treatment of chronic myelogenous leukemia change the prognosis of this group of patients. Results of the study performed confirmed that TKI treatment tolerance in most of the patients is good. Five-years follow-up of IRIS study revealed that 4.9% patients discontinued first-line treatment with imatinib due to adverse effects appearance. Similarly, good tolerance profile was confirmed in a case of 2-generation of TKI — nilotinib (NILO) and dasatinib (DAZA). Mostly, side effects appearance is observed in first months/year of TKI treatment. Rarely, its occurrence leads to discontinuation of the treatment applied. Most frequently, non-hematologic toxicity is observed (nausea, vomiting, diarrhea, skin changes including macula-popular rush, utricaria, fotosensibilisation, and superficial edemas, fluid retention, muscle crump, headache) or hematologic toxicity (granulocytopenia, thrombocytopenia, anaemia). Rarely, TKI administration leads to hyperglycemia, rise in blood amylase activity or bilirubin concentration, and appearance the symptoms of peripheral artery occlusive disease (NILO) orpericardial/pleural effusion, pulmonary artery hypertension (DAZA). When they are noted, interactions with other drugs interfering with metabolism of TKI and increasing its toxicity should be excluded. Monitoring and recommendations concerning TKI related adverse effect treatment is a topic of this paper.