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Original Article
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Dynamics and management of cytopenias associated with dasatinib therapy in patients with chronic myeloid leukemia in chronic phase after imatinib failure
Article first published online: 10 JUN 2009
DOI: 10.1002/cncr.24432
Copyright © 2009 American Cancer Society
Additional Information
How to Cite
Quintás-Cardama, A., De Souza Santos, F. P., Kantarjian, H., O'Brien, S., Faderl, S., Awais, A., Borthakur, G. and Cortes, J. (2009), Dynamics and management of cytopenias associated with dasatinib therapy in patients with chronic myeloid leukemia in chronic phase after imatinib failure. Cancer, 115: 3935–3943. doi: 10.1002/cncr.24432
Publication History
- Issue published online: 20 AUG 2009
- Article first published online: 10 JUN 2009
- Manuscript Accepted: 22 JAN 2009
- Manuscript Revised: 15 JAN 2009
- Manuscript Received: 1 OCT 2008
- Abstract
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Keywords:
- cytopenias;
- chronic myeloid leukemia;
- dasatinib;
- imatinib;
- chronic phase;
- toxicity;
- treatment interruption
Characteristics of the cytopenias that occurred in patients with chronic myeloid leukemia in chronic phase who received dasatinib therapy after imatinib failure were investigated. Management of the cytopenias included transient dasatinib interruption in some patients and the addition of growth factors in some patients. Treatment interruption and/or dose reduction as well as growth factor support were effective strategies that were found to facilitate the continuous administration of dasatinib.
Abstract
BACKGROUND:
The incidence, dynamics, and management of cytopenias were investigated in patients with chronic myeloid leukemia in chronic phase (CP CML) who received dasatinib therapy after imatinib failure.
METHODS:
Data were analyzed from 130 patients with CP CML who were treated with dasatinib from November 2003 to March 2006 in phase 1 (n = 22) or phase 2 or 3 (n = 108) studies for the development of grade 2 to 4 cytopenia (according to the National Cancer Institute Common Terminology Criteria [version 3.0]).
RESULTS:
Grade 2 to 4 neutropenia and/or thrombocytopenia occurred in 94 (72%) patients during dasatinib therapy and grade 3 to 4 occurred in 67 (52%) patients. Of the 94 patients who developed grade 2 to 4 neutropenia and/or thrombocytopenia, 64 (68%) also developed at least grade 2 anemia, and 16 (17%) developed grade 3 to 4 anemia. Management of cytopenias included transient dasatinib interruption in 35 (37%) patients, filgrastim in 12 (14%) patients, recombinant erythropoietin in 29 (45%) patients, and interleukin-11 in 3 (5%) patients. Factors associated with an increased risk for developing grade 2 to 4 cytopenias were longer time from diagnosis to treatment, prior interferon or imatinib therapy, and a lower white blood cell count at the initiation of dasatinib therapy.
CONCLUSIONS:
Hematologic toxicity was frequent during dasatinib therapy in patients with CP CML, particularly at doses >100 mg daily. Treatment interruption and/or dose reduction as well as growth factor support were found to be safe and efficacious strategies to facilitate the continuous administration of dasatinib. Cancer 2009. © 2009 American Cancer Society.