Incidences of hematological adverse reactions in 435 patients with chronic myeloid leukemia treated by imatinib mesylate
0
Citation
0
Reference
20
Related Paper
Abstract:
Objective
To explore the hematology adverse reactions of imatinib mesylate (IM) in the treatment of chronic phase (CP) of chronic myeloid leukemia (CML).
Methods
The clinical data of 435 CML-CP patients treated with IM were analyzed respectively in the Affiliated Cancer Hospital of Zhengzhou University from Jan 2013 to Jan 2015. The hematology adverse reactions were followed up regularly and the incidences in different groups with various factors were compared.
Results
Until the end of follow-up, 74 (17.0 %) patients had hematology adverse reactions. 61 (14.02 %) patients had neutropenia, including 9 (14.75 %) patients who had level Ⅲ-Ⅳ neutropenia. 60 (13.79 %) cases had thrombocytopenia including 11 (18.33 %) patients with level Ⅲ-Ⅳ thrombocytopenia. Anemia occurred in 50 (11.49 %) patients, of whom 5 (10.00 %) cases were grade Ⅲ-Ⅳ anemia. 33 (7.59 %) cases experienced pancytopenia. The incidence of hematology adverse reactions was influenced by nine factors, including the course before treatment, the size of spleen, Sokal scores, the use of interferon, fusion genes, chromosomes, complete cytogenetic response, main molecular reaction and Karnofsky scores (all P 0.05).
Conclusions
During the initial treatment of CML-CP, if patients experienced level Ⅰ-Ⅱ hematology adverse reactions, they can continue to taking IM. However, when level Ⅲ-Ⅳ hematology adverse reactions happened, they need to reduce the dose or stop taking, and one month later, hemocyte will get well. In the long-term treatment of CML, once level Ⅲ-Ⅳ hematology adverse reactions occur, the patients need to receive some related inspections, such as bone marrow morphology and molecular biology detection, to clear the disease stage. When it is necessary, the patients can take the second generation of tyrosine kinase inhibitors.
Key words:
Leukemia, myeloid, chronic; Imatinib mesylate; Hematology adverse reactionsKeywords:
Hematology
Imatinib Mesylate
Leukopenia
Background/Aim. Imatinib mesylate, a tyrosine kinase inhibitor with specific activity against the breakpoint cluster region - Abelson murine leukemia (BCR-ABL) tyrosine kinase has been developed for treatment of chronic myelogenous leukemia (CML). Its hematologic and cytogenetic effects have been evaluated in a series of clinical trials. The aim of this study was to report hematologic and cytogenetic response in CML patients during the treatment with imatinib mesylate. Methods. A total of 21 patients were treated and observed from July 2006 to December 2008. The median time from CML diagnosis was no more than 12 months, so all the patients received previous treatment with hydroxyurea for which the median time was 3 months. The patients received imatinib mesylate in an effective oral dose of 400 to 800 mg daily, which was followed with peripheral blood counts, bone marrow examination, and cytogenetic studies at 6, 12, 18 and 24 months. Results. Complete hematologic responses were reported for 19 (90.48%) of 21 patients studied. Among 19 patients who had a response, 16 (86%) did so within 3 months. The best cytogenetic response rate at any time during the study treatment with imatinib mesylate, among 14 patients in which cytogenetic response evaluated was: complete cytogenetic response in 7 (50%) patients, partial cytogenetic response in 6 (42.9%) patients and minor cytogenetic response in 1 (7.1%) patient. No patients had progressed to accelerated or blastic phase. The most frequent adverse effects that seemed to be related to treatment with imatinib mesylate were edema and musculosceletal pain; overall, most were mild. Only one patient discontinued treatment because of hematologic toxic effects. Conclusion. The results obtained in this study confirm that imatinib mesylate induces a complete hematological and cytogenetic response in a high percentage of patients with chronic-phase CML.
Imatinib Mesylate
Chronic myelogenous leukemia
Mesylate
Philadelphia chromosome
Peripheral edema
Cite
Citations (1)
Imatinib Mesylate
Peripheral edema
Muscle cramp
Cite
Citations (0)
Imatinib mesylate (STI 571; Glivec) is a potent and selective tyrosine kinase inhibitor. The introduction of imatinib has chanced the philosophy of mechanisms of cancer therapy and already changed current management of patients with chronic myeloid leukemia (CML). A total of 49 patients with later chronic phase CML in whom previous therapy with interferon alpha had failed were treated with 400 mg of oral imatinib daily. Patients were evaluated for hematologic and cytogenetic responses. Time to progression, survival, and toxic effects were also evaluated. Complete hematologic responses were reported for 48 of 49 patients studied (98 percent). The median time to a complete hematologic response was 1.2 month; 89% of patients who had a response did so within 4 months. Imatinib induced major cytogenetic responses in 73%; 62% had a complete responses. After a median follow-up of 18 months, CML had not progressed to the accelerated or blast phases in an estimated 98% of patients, and 100 percent of the patients were alive. Grade 3 or 4 nonhematologic toxic effects were manageable. No one of patients discontinued treatment due to of drug-related adverse events, and no treatment-related deaths occurred. The results of current study indicate that imatinib has a significant therapy benefit in CML patients in whom treatment with IFN alpha had failed. Therefore, has favorably changed the prognosis for patients with chronic myelogenous leukemia.
Imatinib Mesylate
Chronic myelogenous leukemia
Philadelphia chromosome
Anagrelide
Interferon alfa
Cite
Citations (10)
OBJECTIVE To evaluate the efficacy and safety of Imatinib(Gleevec)for patients with Ph positive chronic myeloid leukemia(CML).METHODS A total of 90 CML patients(67 in chronic phase,14 in accelerated phase and 9 in blast crisis)were treated with 400 mg,600 mg and 800 mg daily of oral Imatinib for 1 to 51 months respectively.All the patients underwent blood routine examination weekly and bone marrow puncture,cytogenetic examination every three months.Dose was adjusted according to the results of the above examinations.RESULTS 84(93.3%)patients achieved complete hematological response.68 patients could evaluate cytogenetic response.Imatinib induced major cytogenetic response in 35(51.5%)patients and complete cytogenetic response in 31 patients(88.6%).Grade 3 or 4 neutropenia or thrombocytopenia occurred in 11(12.2%)patients,which were manageable or tolerated.Grade 3 or 4 nonhematologic adverse effects were infrequent.CONCLUSION Imatinib induced high rate of cytogenetic and hematologic responses in patients with Ph positive CML.The adverse effects were mild and manageable or no need for treatment.
Chronic myelogenous leukemia
Blast Crisis
Leukopenia
Cite
Citations (0)
Objective To evaluate the effccts and to analyse the adverse effects of imatinib mesylate for patients with chronic myelogenous leukemia in chronic phase.Methods Twenty patients with CML-CP were treated with 300~800 mg/d of imatinib mesylate.To monitore the routine blood test,karyotype and the transcripts expression of bcr/abl P210.To adverse reactions observed during the treatment.Results 20 cases of CMLpatients with median follow-up time for 15 months,18 cases(90.0%) achieved CHR,16 cases(80.0%) achieved the main cytogenetics remission,and 6 cases(42.9%) received the molecular biology remission.Adverse effects:(1) Non-hematologic toxicity:such as superficial edema(fluid retention) for 9 cases,Musculoskeletal pain for 7 cases,Joint pain for 6 cases,headache for 3 cases.These adverse effects were disappeared after 3 months.(2) Hematologic toxicity:After the treatment for 3 months,in all 20 cases,there were 13 cases had panleukopenia,9 cases had thrombocytopenia and 2 cases had anemia.After 6 months,in 18 cases,there were 7 cases had panleukopenia,5 cases had thrombocytopenia and 2 cases had anemia.After 12 months,in 10 cases,there were 3 cases had panleukopenia,3 cases had thrombocytopenia and there was no cases had anemia.None had SGOT/SGPT or bilirubin increased.Conclusion Imatinib mesylatee can receive high a Complete Hematologic Remission rate and a high rate of the main cytogenetics remission in CML-CP patients.The adverse effects occurred in the early phase of the imatinib mesylatee treatment,related with its clearing malignant clone.The incidence of adverse events associated with the treatment significantly reduce with the restoration of normal hematopoiesis.
Imatinib Mesylate
Chronic myelogenous leukemia
Philadelphia chromosome
Cite
Citations (0)
To evaluate the relationship between cytopenia and cytogenetic response in Imatinib mesylate treated Ph-positive chronic myeloid leukemia (CML) in chronic phase patients.Fifty-four patients with Ph + CML in chronic phase received oral administration of Imatinib 400 or 600 mg once a day for 18 months.In the early phase of Imatinib treatment, rates of severe leukopenia (leukocyte < 2.0 x 10(9) L-1), anemia (hemoglobin < 100 g.L-1) and severe thrombocytopenia (platelet < 50 x 10(9) L-1) were 14.8%, 37.0% and 27.8%, respectively. Hemocytes recovered in most patients with continued therapy. Treatment was interrupted or dosage reduced in a few patients. The lower the hemoglobin and higher the platelet before the regime, the lower the nadir of leukocytes and hemoglobin counts during the treatment. The lower the platelet count before the regime, the lower the nadir of platelets during the treatment. Risk factors for severe leukopenia were thrombocytosis (> or = 500 x 10(9) L-1) and basophilia > or = 5% before the treatment. Risk factors for severe thrombocytopenia were thrombocytopenia (< 100 x 10(9) L-1) and basophilia > or = 5% before the treatment. During the 12-month treatment with Imatinib, the statistically significant lower probabilities of cytogenetic response were observed at all checked points in patients with severe leukopenia, at the end of 3 and 6 months in patients with anemia, at the end of 3 months in patients with severe thrombocytopenia.Cytopenia is a common side effect in patients with CML in chronic phase treated with Imatinib mesylate. Severe leukopenia is associated with a sustained lower major cytogenetic response, whereas anemia and severe thrombocytopenia influence more for the first 6 months.
Cytopenia
Imatinib Mesylate
Leukopenia
Basophilia
Thrombocytosis
Cite
Citations (5)
Objective
To evaluate the efficacy and safety of tyrosine kinase inhibitors (TKI) in treating the elderly patients with chronic myeloid leukemia (CML) during chronic phrase.
Methods
From January 2015 to January 2016, a total of 52 cases of chronic phrase CML patients who received TKI treatment, over 60-year-old and were treated at Department of Hematology, West China Hospital were included in this study. Thirty-three cases of them chose imatinib (IM) as the first-line treatment regimen and 2 cases of them chose nilotinib (NIL) as the first-line treatment regimen, while the other 17 cases were treated with interferon before IM. The therapeutic response, overall survival (OS), event-free survival (EFS), comorbidity and drug-related adverse reactions of all the patients were analyzed by retrospective method, in order to summarize the efficacy and safety of TKI in the treatment of CML in elderly patients.
Results
① The rates of cumulative complete hematologic response (CHR), major cytogenetic response (MCyR), complete cytogenetic response (CCyR) and major molecular response (MMR) were 100.0% (52/52), 82.7 % (43/52), 80.8 % (42/52) and 71.2 % (37/52), respectively. The rates of OS of 1-year, 5-year and 10-year were 100.0%, 95.1% and 75.3%, respectively, while the rates of EFS of 1-year, 5-year and 10-year were 92.3%, 73.3% and 51.4%, respectively. ② Twenty-five patients had comorbidities. The scores of Charlson comorbidity index (CCI) of these 52 patients were all less than 2 scores. There were no significant differences in the incidence of cumulative CCyR, MCyR, MMR, grade Ⅲ hematologic and non-hematologic adverse reactions between 32 patients with CCI score=0 and 20 patients with CCI score>0 (χ2=0.948, 0.525, 0.021, 0.288, 0.021; P>0.05). ③ In 50 patients who received treatment of IM, the incidence rates of Ⅲ-Ⅳ grade neutropenia, thrombocytopenia and anemia were 16.0 % (8/50), 28.0% (14/50) and 18.0% (9/50), respectively. While 14 patients occurred Ⅲ-Ⅳ grade non-hematologic adverse reactions, with the incidence rate of 28.0% (14/50). Due to intolerance of IM, 5 cases (10.0%, 5/50) of the patients received the second-line TKI treatment.
Conclusions
TKI is an effective and safe treatment for the elderly patients who have chronic phrase CML. Mild comorbidities have no influence on the therapy.
Key words:
Leukemia, myelogenous, chronic, BCR-ABL positive; Tyrosine kinase inhibitor; Aged; Drug-related side effects and adverse reactions; Comorbidity
Regimen
Cite
Citations (0)
Objective To discuss the observation and nursing of adverse reactions in chronic myelocytic leukemia patients receiving imatinib therapy.Methods Adverse reactions were observed and recorded in 193 chronic phase myelocytic leukemia patients who received imatinib therapy,and corresponding treatment and nursing were given to them.Results Among 193 patients,more than 60％ of patients had adverse reactions,of which,54％ of patients showed gastrointestinal adverse reactions including nausea,vomiting,anepithymia and diarrhea; 22％ of them had muscle and bone pain; 7％ had rash; 65％ got edema.After proper treatment and nursing,all adverse effects obtained satisfactory remission.Condusions During the treatment course of chronic myelocytic leukemia patients using imatinib,careful observation of any possible adverse reactions,and giving corresponding treatment and nursing can facilitate good compliance and longterm remission of patients.
Key words:
Imatinib; Chronic myelocytic leukemia; Adverse reactions; Nursing care
Myelocytic leukemia
Chronic leukemia
Cite
Citations (0)
The incidence of grade 3-4 anemia was reported to be 3% with imatinib therapy for newly diagnosed chronic myeloid leukemia (CML) in the chronic phase (CP). However, there are few data regarding the causes and the development of anemia after long-term treatment. This study aimed to evaluate the incidence of anemia after at least two years of imatinib treatment of CML patients in the CP and to identify other contributing causes of anemia in this population.We performed a retrospective analysis of 97 CML patients in the CP treated with imatinib for at least two years. We analyzed the hemoglobin (Hb) levels of CML patients at diagnosis, upon initiation of treatment with imatinib and after two years of imatinib treatment, and investigated other causes of anemia in this population.Most of the patients presented Hb levels below the normal range (80.4%) after the second year of treatment, 17.9% grade 2 and 1.3% grade 3. In 13 cases (16.7%), anemia was attributed to resistance and in 13 cases (16.7%) the following causes were identified: iron deficiency (n=5), hypothyroidism (n=2), vitamin B12 deficiency (n=3), acquired immune deficiency syndrome (AIDS) (n=1), pulmonary tuberculosis (n=1) and renal toxicity (n=1). In 52 patients (66.6%), there were no other factors contributing to anemia, except imatinib treatment.Regular follow-up is required to identify the causes of anemia not related to CML or imatinib toxicity. The importance of investigating secondary causes of anemia should be emphasized, especially in patients with good adherence to treatment and satisfactory therapeutic response.
Imatinib Mesylate
Cite
Citations (15)
Objective To evaluate the efficacy and safety of Gleevec (Imatinib) in the treatment of patients with Ph positive chronic myeloid leukemia in chronic phase (CML-CP). Methods A total of 54 CML-CP patients in whom previous therapy with interferon-α had been failed or untolerated, or relapsed after allogeneic stem cell transplantation(allo-SCT)were treated with 400 mg/d of oral Gleevec for 6 to 11 months. Result Fifty-three patients being able to evaluate achieved complete hematological response within 7 to 28 days. Fifty-two (98%) of them remained in this situation at last follow-up. One patient relapsed after 7 months' treatment, and progressed to accelerated phase. Gleevec induced major cytogenetic response in 37 patients (70%) and complete cytogenetic response in 27 (51%). Twenty-nine of 37 patients (78%) achieved major cytogenetic response within 3 months. Grade 3 neutropenia or thrombocytopenia occurred in about 10% of patients, which were manageable or tolerated. Grade 3 or 4 nonhematologic adverse effects were infrequent. Only 1 patient (2%) discontinued treatment because of drug-related adverse events. Conclusions Gleevec induced high rate of cytogenetic and hematologic responses in patients with CML-CP who failed in previous interferon therapy.The adverse effects were mild and manageable, or no need for treatment.
Chronic myelogenous leukemia
Leukopenia
Cite
Citations (0)