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Özmen D, Alpaydın DD, Saldoğan MA, Eşkazan AE. A safety review of tyrosine kinase inhibitors for chronic myeloid leukemia. Expert Opin Drug Saf 2024; 23:411-423. [PMID: 38484148 DOI: 10.1080/14740338.2024.2331190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Since the introduction of first tyrosine kinase inhibitor (TKI) imatinib, the treatment of chronic myeloid leukemia (CML) has reached excellent survival expectancies. Long survival rates bring about issues regarding TKI safety. AREAS COVERED The aim of this review is to compare the side effects of current TKIs both in the first and later lines and outline a safety andprofile of CML treatment. Seminal studies on TKIs and other newer drugs and extended follow-up of these studies; real-life data of each drug were usedduring the course of this. PubMed was used as a search database and onlyarticles in English were included. EXPERT OPINION With longer follow-up CML patients, resistant slowgrade adverse events seem to be the major obstacle in the way of treatmentefficacy. If efficacy is the priority, vigorous treatment of side effect and administration of full dose TKI are reasonable. But when treatment goals are reached, dose modifications or alternative treatment regimens may be acceptedpossible. More studies are needed on dose modification protocols and potential benefits and safety of treatment-free remission.
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Affiliation(s)
- Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Duygu Demet Alpaydın
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Saydam G, Unal A, Haznedaroglu IC, Hacihanifioglu A, Mehtap O, Kurtoglu E, Gocer M, Turgut M, Kelkitli E, Atay MH, Guler N, Koluman BU, Sonmez M, Erkut N, Kaya E, Kuku I, Erkurt MA, Ozet G, Ceran F, Sahin F, Soyer N, Nalcaci M, Yilmaz M, Bozkurt S, Aver B, Ozdengulsun B, Ozbilgili E, Ilhan O. Turkey real-life data: demographic features, treatment results and effects of comorbidities in chronic myeloid leukemia. Int J Hematol Oncol 2022; 11:IJH40. [PMID: 36101779 PMCID: PMC9453544 DOI: 10.2217/ijh-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to identify patient characteristics, treatment patterns and outcomes and to evaluate the effects of presence of comorbidities at diagnosis in chronic phase (CP)-chronic myeloid leukemia (CML) patients in Turkey. Materials & methods: Hospital records between 2005 and 2018 were retrospectively reviewed. Results: Of 861 CP-CML patients included, 31% had at least one comorbidity at diagnosis. Sex, cardiovascular disease status at diagnosis and molecular (at least major) and cytogenetic (partial and complete) responses were the independent predictors of survival. Conclusion: The response rates of CP-CML patients to the tyrosine kinase inhibitors were satisfactory. In addition to tolerability and side effect profiles of drugs, comorbidity status of patients should also be considered in treatment choice in CML patients. This study aimed to identify patient characteristics, treatment patterns and outcomes and to evaluate the effects of presence of comorbidities at diagnosis in chronic phase (CP)-chronic myeloid leukemia (CML) patients in Turkey. Hospital records of patients between 2005 and 2018 were retrospectively reviewed. Of the included 861 CP-CML patients, 31% had at least one comorbidity at diagnosis. The survival of the patients was affected by sex, cardiovascular disease status at diagnosis, and molecular (at least major) and cytogenetic (partial and complete) responses. The response rates of CP-CML patients to the tyrosine kinase inhibitors were satisfactory. In addition to tolerability and side effect profiles of drugs, comorbidity status of patients should also be considered in treatment choice in CML patients.
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Affiliation(s)
- Guray Saydam
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Ali Unal
- Department of Internal Diseases, Division of Hematology, Erciyes University Faculty of Medicine, Kayseri, 38030, Turkey
| | | | - Abdullah Hacihanifioglu
- Department of Internal Diseases, Division of Hematology, Kocaeli University Faculty of Medicine, Izmit, 41001, Turkey
| | - Ozgur Mehtap
- Department of Internal Diseases, Division of Hematology, Kocaeli University Faculty of Medicine, Izmit, 41001, Turkey
| | - Erdal Kurtoglu
- Department of Internal Diseases, Division of Hematology, University of Health Sciences, Antalya Training & Research Hospital, Antalya, 07100, Turkey
| | - Mesut Gocer
- Department of Internal Diseases, Division of Hematology, University of Health Sciences, Antalya Training & Research Hospital, Antalya, 07100, Turkey
| | - Mehmet Turgut
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Engin Kelkitli
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Memis Hilmi Atay
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Nil Guler
- Department of Internal Diseases, Pamukkale University Faculty of Medicine, Denizli, 20160, Turkey
| | - Basak Unver Koluman
- Department of Internal Diseases, Pamukkale University Faculty of Medicine, Denizli, 20160, Turkey
| | - Mehmet Sonmez
- Department of Internal Diseases, Division of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon, 61080, Turkey
| | - Nergiz Erkut
- Department of Internal Diseases, Division of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon, 61080, Turkey
| | - Emin Kaya
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Irfan Kuku
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Mehmet Ali Erkurt
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Gulsum Ozet
- Department of Hematology, Ankara City Hospital, Ankara, 06800, Turkey
- Department of Internal Diseases, Ankara Yıldırım Beyazit University Faculty of Medicine, Ankara, 06800, Turkey
| | - Funda Ceran
- Department of Hematology, Ankara City Hospital, Ankara, 06800, Turkey
| | - Fahri Sahin
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Nur Soyer
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Meliha Nalcaci
- Department of Internal Diseases, Istanbul University Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
| | - Mehmet Yilmaz
- Department of Internal Diseases, Division of Hematology, SANKO University Faculty of Medicine, Gaziantep, 27090, Turkey
| | - Sirac Bozkurt
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Birkan Aver
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Begum Ozdengulsun
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Egemen Ozbilgili
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Osman Ilhan
- Department of Internal Diseases, Division of Hematology, Ankara University Faculty of Medicine, Ankara, 06230, Turkey
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Eskazan AE, Ali R, Alnıgeniş E, Ayyıldız O, Haznedaroğlu İ, Kırkızlar O, Kurtoğlu E, Malhan S, Öksüz E, Polat Ö, Saydam G, Sönmez M, Toprak SK, Toptaş T, Turgut M. Patient characteristics and management practices in chronic myeloid leukemia in Turkey: reflections from an expert meeting. Expert Rev Hematol 2022; 15:97-106. [DOI: 10.1080/17474086.2022.2044779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ridvan Ali
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ebru Alnıgeniş
- Department of Medical Affairs, Novartis Pharmaceuticals Corporation, Istanbul, Turkey
| | - Orhan Ayyıldız
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - İbrahim Haznedaroğlu
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Onur Kırkızlar
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Erdal Kurtoğlu
- Division of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Simten Malhan
- Department of Health Care Management, Faculty of Health Sciences, Başkent University, Ankara, Turkey
| | - Ergün Öksüz
- Department of Family Medicine, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Özlem Polat
- Department of Medical Affairs, Novartis Pharmaceuticals Corporation, Istanbul, Turkey
| | - Güray Saydam
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Mehmet Sönmez
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Selami Koçak Toprak
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tayfur Toptaş
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Mehmet Turgut
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Shojaei M, Rezvani H, Azarkeivan A, Poopak B. ABL Kinase Domain Mutations in Iranian Chronic Myeloid Leukemia Patients with Resistance to Tyrosine Kinase Inhibitors. Lab Med 2020; 52:158-167. [PMID: 32821940 DOI: 10.1093/labmed/lmaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Tyrosine kinase inhibitors (TKIs) are considered standard first-line treatment in patients with chronic myeloid leukemia. Because ABL kinase domain mutations are the most common causes of treatment resistance, their prevalence and assessment during treatment may predict subsequent response to therapy. METHODS The molecular response in Bcr-Abl1IS was tested via quantitative real-time polymerase chain reaction. We used the direct sequencing technique to discover the mutations in the ABL kinase domain. The IRIS trial established a standard baseline for measurement - (100% BCR-ABL1 on the 'international scale') and a major molecular response (good response to therapy) was defined as a 3-log reduction in the amount of BCR-ABL1 - 0.1% BCR-ABL1 on the international scale. RESULTS We observed 11 different mutations in 13 patients, including E255K, which had the highest mutation rate. A lack of hematologic response was found in 22 patients, who showed a significantly higher incidence of mutations. CONCLUSION Detection of kinase domain mutations is a reliable method for choosing the best treatment strategy based on patients' conditions, avoiding ineffective treatments, and running high-cost protocols in patients with acquired resistance to TKIs.
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Affiliation(s)
- Mahboobeh Shojaei
- Iranian Blood Transfusion Organization, High Institute of Research and Education in Transfusion Medicine, Tehran, Iran
| | - Hamid Rezvani
- Hematology and Oncology Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Azarkeivan
- Iranian Blood Transfusion Organization, High Institute of Research and Education in Transfusion Medicine, Tehran, Iran
| | - Behzad Poopak
- Department of Hematology, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran
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Haznedaroğlu İC, Kuzu I, İlhan O. WHO 2016 Definition of Chronic Myeloid Leukemia and Tyrosine Kinase Inhibitors. Turk J Haematol 2020; 37:42-47. [PMID: 31612694 PMCID: PMC7057757 DOI: 10.4274/tjh.galenos.2019.2019.0241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023] Open
Abstract
Philadelphia (Ph*)/BCR-ABL1-positive chronic myeloid leukemia (CML) is considered as a chronic life-long disease, which could be manageable with tyrosine kinase inhibitor (TKI) drugs. The aim of TKI drug treatment is to provide age- and sex-matched duration of life in a given patient with CML. Personalized CML treatment with TKI drugs is the key strategy. Individual treatment approach includes the harmonization of CML disease characteristics, clinical experience, and best available clinical evidence. Specific CML disease characteristics in a given patient include; CML disease risk, comorbidities, molecular profile, compliance, lifestyle, and drug off-target risk profile. CML research evidence includes; randomized clinical trials indicating the data on the efficacy, safety, tolerability, toxicity, possible long-term adverse events, and pharmacoeconomy of TKIs. Clinical and physician experience includes TKI availability, TKI reimbursability, drug experience, adherence, and BCR-ABL1 monitorization facilities. The key decision of choosing a TKI of choosing TKIs for CML should be made via the consideration of these variables. The aim of this paper is to outline the latest 2016 World Health Organization definition of CML and its proper management with TKI-class drugs.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Combined Modality Therapy
- Disease Management
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Molecular Targeted Therapy/methods
- Neoplasm Grading
- Neoplasm Staging
- Practice Guidelines as Topic
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Treatment Outcome
- World Health Organization
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Affiliation(s)
| | - Işınsu Kuzu
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Osman İlhan
- Ankara University Faculty of Medicine, Therapeutic Apheresis Unit, Department of Hematology, Ankara, Turkey
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Bonifacio M, Stagno F, Scaffidi L, Krampera M, Di Raimondo F. Management of Chronic Myeloid Leukemia in Advanced Phase. Front Oncol 2019; 9:1132. [PMID: 31709190 PMCID: PMC6823861 DOI: 10.3389/fonc.2019.01132] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Management of chronic myeloid leukemia (CML) in advanced phases remains a challenge also in the era of tyrosine kinase inhibitors (TKIs) treatment. Cytogenetic clonal evolution and development of resistant mutations represent crucial events that limit the benefit of subsequent therapies in these patients. CML is diagnosed in accelerated (AP) or blast phase (BP) in <5% of patients, and the availability of effective treatments for chronic phase (CP) has dramatically reduced progressions on therapy. Due to smaller number of patients, few randomized studies are available in this setting and evidences are limited. Nevertheless, three main scenarios may be drawn: (a) patients diagnosed in AP are at higher risk of failure as compared to CP patients, but if they achieve optimal responses with frontline TKI treatment their outcome may be similarly favorable; (b) patients diagnosed in BP may be treated with TKI alone or with TKI together with conventional chemotherapy regimens, and subsequent transplant decisions should rely on kinetics of response and individual transplant risk; (c) patients in CP progressing under TKI treatment represent the most challenging population and they should be treated with alternative TKI according to the mutational profile, optional chemotherapy in BP patients, and transplant should be considered in suitable cases after return to second CP. Due to lack of validated and reliable markers to predict blast crisis and the still unsatisfactory results of treatments in this setting, prevention of progression by careful selection of frontline treatment in CP and early treatment intensification in non-optimal responders remains the main goal. Personalized evaluation of response kinetics could help in identifying patients at risk for progression.
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Affiliation(s)
| | - Fabio Stagno
- Division of Hematology With BMT, AOU Policlinico “Vittorio Emanuele”, University of Catania, Catania, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Francesco Di Raimondo
- Division of Hematology With BMT, AOU Policlinico “Vittorio Emanuele”, University of Catania, Catania, Italy
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Alqasim AMZ, Obaid GM, Yaseen YG, Alwan AF. Effects of nilotinib on platelet function in patients with chronic myeloid leukemia in chronic phase. Leuk Res Rep 2019; 11:46-50. [PMID: 31293883 PMCID: PMC6594045 DOI: 10.1016/j.lrr.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/08/2018] [Accepted: 05/29/2018] [Indexed: 11/15/2022] Open
Abstract
Background Tyrosine kinases are highly expressed in platelets and play an important role in their activation process. Some studies have reported the blocking effects of tyrosine kinase inhibitors on different platelet functions. Objectives Evaluate the effects of nilotinib on platelets aggregation in 42 patients with chronic phase of CML and correlate the results with clinical and hematological parameters: age, complete blood count and presentation. Patients and methods This study was conducted on 42 patients diagnosed as Chronic Phase of Chronic Myeloid Leukemia based on clinical, morphological and cytogenetic study. All patients were on Nilotinib treatment and were attending the National Center of Hematology in Baghdad. About 9 mL of venous blood sample were collected from each patient and control subjects, samples divided into 3 parts for complete blood count, platelet aggregation test and PT and aPTT. Results The mean age was 41.3 ± 1.7 (mean ± SEM) years old. M:F ratio of 1.2:1. Mean duration of nilotinib therapy(1.4 years). All patients had normal PT and aPTT.Only 16 (38%) patients had abnormal aggregation response to epinephrine, but there was no statistically significant differences with control group. Conclusion Nilotinib had no adverse effect on platelet function nor patients clotting tests.
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Affiliation(s)
| | | | | | - Alaa Fadhil Alwan
- University of Mustansiriyah, National Center of Hematology, Baghdad, Iraq
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Eskazan AE. Vascular Adverse Events During Long-term Nilotinib Therapy in Patients With Chronic Myeloid Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2017; 17:e63-e64. [PMID: 28830672 DOI: 10.1016/j.clml.2017.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Co-administration of cyclosporine A and imatinib among patients with Philadelphia chromosome-positive leukemias in the post-transplant setting. Eur J Clin Pharmacol 2016; 72:1537-1538. [PMID: 27558360 DOI: 10.1007/s00228-016-2122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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Abruzzese E, Trawinska MM, de Fabritiis P, Baccarani M. Management of pregnant chronic myeloid leukemia patients. Expert Rev Hematol 2016; 9:781-91. [PMID: 27352939 DOI: 10.1080/17474086.2016.1205479] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Since the introduction of tyrosine kinase inhibitors (TKIs) therapy, chronic myeloid leukemia (CML), has moved from a fatal illness to a manageable disease with a possible normal lifespan. For this reason is more and more frequent that younger patients address the possibility to conceive, if men, or get pregnant, if women. Knowledge of safety and risks concerning both patient and progeny, as well as important cultural, ethical and psychosocial issues must be taken into consideration. AREAS COVERED Data published and informations acquired in terms of fertility, conception, pregnancy, pregnancy outcome and illness control for all the approved TKIs will be reviewed, as well as suggest how to manage a planned and/or unplanned pregnancy/conception. Literature search methodology included examination of PubMed index, meeting presentations, and updated Investigator's brochures and data files of TKIs companies. Expert commentary: Male patients trying to conceive apparently have no limitation in the use of TKIs, while effective contraception should be encouraged in all female patients due to the risk of fetal complications after drug exposure. In a female patient pregnancy should be planned and TKI therapy discontinued, while individual risks need to be considered when an unplanned pregnancy occurs.
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Affiliation(s)
| | | | - Paolo de Fabritiis
- a Hematology, S. Eugenio Hospital , Tor Vergata University , Rome , Italy
| | - Michele Baccarani
- b Department of Hematology & Oncology 'L. and A. Seràgnoli' , S.Orsola-Malpighi University Hospital , Bologna , Italy
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Eskazan AE, Elverdi T, Yalniz FF, Salihoglu A, Ar MC, Ongoren Aydin S, Baslar Z, Aydin Y, Tuzuner N, Ozbek U, Soysal T. The efficacy of generic formulations of imatinib mesylate in the treatment of chronic myeloid leukemia. Leuk Lymphoma 2014; 55:2935-7. [DOI: 10.3109/10428194.2014.905774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chronic myeloid leukemia patients who develop grade I/II pleural effusion under second-line dasatinib have better responses and outcomes than patients without pleural effusion. Leuk Res 2014; 38:781-7. [PMID: 24832371 DOI: 10.1016/j.leukres.2014.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/05/2014] [Accepted: 04/08/2014] [Indexed: 12/30/2022]
Abstract
Dasatinib is a potent second generation TKI, and it is widely used in patients with CML, both in the up-front setting and failure after imatinib. Lymphocytosis in cases receiving dasatinib therapy has been shown to be associated with pleural effusion (PE) and better outcome. Although patients who gather lymphocytosis during dasatinib have superior responses, there is only little data about the correlation between PE, response rates, and survival. In order to answer this question, the aim of our study was to determine the frequency of PE and lymphocytosis among our CML patients receiving second-line dasatinib, and to compare the responses and outcomes between patients with or without PE. There were 18 patients (44%) who developed PE, in a total of 41 patients, with a median time of 15 months. Lymphocytosis was observed in nine patients (9/41, 22%) with a median duration of 6.5 months of dasatinib treatment. There were fourteen patients with at least one comorbidity that may play a role in the generation of PE. The cumulative MMR and CCyR rates were greater in PE+ patients (p<0.05). The PFS was significantly higher in PE+ group than PE- patients (p=0.013), also the OS was higher among PE+ patients than PE- group (p=0.042). In patients with a grade I/II PE, and durable responses under dasatinib, performing the management strategies for the recovery of effusion, together with continuing dasatinib can be a reasonable choice mainly in countries where third generation TKIs are not available. But alternative treatment strategies such as nilotinib or third generation TKIs can be chosen in patients with grade III/IV PE especially if the quality of life is severely affected.
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