Review Article

Tyrosine Kinase Inhibitors for the Treatment of Chronic-Phase Chronic Myeloid Leukemia: Long-Term Patient Care and Management

Stephanie Bauer,¹ RN, MSN, BC-FNP, Susan Buchanan,² MS, PA-C, and Irene Ryan,³ PA-C

¹Department of Internal Medicine, Washington University, St. Louis, Missouri; ²Adult Leukemia Program, Dana-Farber Cancer Institute, Boston, Massachusetts; ³Department of Internal Medicine and Department of Hematology/Oncology, University of Michigan Health System, Ann Arbor, Michigan

Authors' disclosures of potential conflicts of interest are found at the end of this article.

Stephanie Bauer, RN, MSN, BC-FNP, Washington University School of Medicine, Department of Internal Medicine, BMT, Campus Box 8007, 660 S. Euclid Avenue, St. Louis, MO 63110. E-mail: sbauer@dom.wustl.edu

ABSTRACT

Several tyrosine kinase inhibitors (TKIs) are now approved for the treatment of chronic myeloid leukemia in chronic phase. The efficacy of these drugs has been repeatedly demonstrated, as has their tolerability in most patients. However, late and chronic toxicities become an important issue for many patients facing long-term TKI exposure. For patients on long-term imatinib, gastrointestinal events, fluid retention, muscle cramps, fatigue, and hepatotoxicity are among the most common and most clinically relevant adverse events (AEs). A few of these have also emerged as important AEs with some of the newer TKIs. Distinct long-term toxicity concerns have emerged for dasatinib (pleural effusion, pulmonary hypertension, headache, and dyspnea) and nilotinib (rash, headache, myalgia, alopecia, and hyperglycemia), whereas due to the recent approval of bosutinib and ponatinib, their long-term toxicity profiles have not been fully characterized. Clinical experience with each of these drugs is accumulating, and ensuring proper adherence and monitoring for potential AEs is essential for effective treatment.

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