Management of Side Effects
Leukemia Insights - Spring 2011
Some of the most common adverse events observed with tyrosine kinase inhibitors and suggested management options37 are listed in the following table.
The most common adverse event seen with tyrosine kinase inhibitors is myelosuppression, with grade 3 or 4 neutropenia (absolute neutrophil count < 1 x109/L) and thrombocytopenia (platelet count < 50 x 109/L) in up to 30% of patients, and anemia in 5% to 15% of patients. Myelosuppression most often occurs early during the course of therapy (first 2-3 weeks) and is transient. For those patients who develop grade 3 or 4 neutropenia or thrombocytopenia, temporary interruption of therapy is recommended37. Therapy can resume once the counts recover to levels above those defining grade 3 cytopenias.
If recovery occurs within 2 weeks, treatment can be reinitiated at the same dose; however, a dose reduction is recommended if recovery takes longer than 2 weeks. Hematopoietic growth factors –filgrastim for neutropenia, epoetin alfa for anemia, and oprelvekin for thrombocytopenia have been reported to benefit patients with recurrent myelosuppression that limits proper administration of therapy38. However, the long-term safety of this approach is not known. In the near future, a clinical trial will be initiated investigating the role of eltrombopag, an agonist of the c-mpl receptor, in correcting thrombocytopenia in patients whose CML therapy is limited by recurrent low platelet counts.
Management of the Most Common Nonhematologic Adverse Events Observed During Therapy with Tyrosine Kinase Inhibitors
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