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European LeukemiaNet recommendations for the management and avoidance of adverse events of treatment in chronic myeloid leukaemia
Most reports on chronic myeloid leukaemia (CML) treatment with tyrosine kinase inhibitors (TKIs) focus on efficacy, particularly on molecular response and outcome. In contrast, adverse events (AEs) are often reported as infrequent, minor, tolerable and manageable, but they are increasingly important...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991363/ https://www.ncbi.nlm.nih.gov/pubmed/27121688 http://dx.doi.org/10.1038/leu.2016.104 |
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author | Steegmann, J L Baccarani, M Breccia, M Casado, L F García-Gutiérrez, V Hochhaus, A Kim, D-W Kim, T D Khoury, H J Le Coutre, P Mayer, J Milojkovic, D Porkka, K Rea, D Rosti, G Saussele, S Hehlmann, R Clark, R E |
author_facet | Steegmann, J L Baccarani, M Breccia, M Casado, L F García-Gutiérrez, V Hochhaus, A Kim, D-W Kim, T D Khoury, H J Le Coutre, P Mayer, J Milojkovic, D Porkka, K Rea, D Rosti, G Saussele, S Hehlmann, R Clark, R E |
author_sort | Steegmann, J L |
collection | PubMed |
description | Most reports on chronic myeloid leukaemia (CML) treatment with tyrosine kinase inhibitors (TKIs) focus on efficacy, particularly on molecular response and outcome. In contrast, adverse events (AEs) are often reported as infrequent, minor, tolerable and manageable, but they are increasingly important as therapy is potentially lifelong and multiple TKIs are available. For this reason, the European LeukemiaNet panel for CML management recommendations presents an exhaustive and critical summary of AEs emerging during CML treatment, to assist their understanding, management and prevention. There are five major conclusions. First, the main purpose of CML treatment is the antileukemic effect. Suboptimal management of AEs must not compromise this first objective. Second, most patients will have AEs, usually early, mostly mild to moderate, and which will resolve spontaneously or are easily controlled by simple means. Third, reduction or interruption of treatment must only be done if optimal management of the AE cannot be accomplished in other ways, and frequent monitoring is needed to detect resolution of the AE as early as possible. Fourth, attention must be given to comorbidities and drug interactions, and to new events unrelated to TKIs that are inevitable during such a prolonged treatment. Fifth, some TKI-related AEs have emerged which were not predicted or detected in earlier studies, maybe because of suboptimal attention to or absence from the preclinical data. Overall, imatinib has demonstrated a good long-term safety profile, though recent findings suggest underestimation of symptom severity by physicians. Second and third generation TKIs have shown higher response rates, but have been associated with unexpected problems, some of which could be irreversible. We hope these recommendations will help to minimise adverse events, and we believe that an optimal management of them will be rewarded by better TKI compliance and thus better CML outcomes, together with better quality of life. |
format | Online Article Text |
id | pubmed-4991363 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Nature Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-49913632016-08-24 European LeukemiaNet recommendations for the management and avoidance of adverse events of treatment in chronic myeloid leukaemia Steegmann, J L Baccarani, M Breccia, M Casado, L F García-Gutiérrez, V Hochhaus, A Kim, D-W Kim, T D Khoury, H J Le Coutre, P Mayer, J Milojkovic, D Porkka, K Rea, D Rosti, G Saussele, S Hehlmann, R Clark, R E Leukemia Review Most reports on chronic myeloid leukaemia (CML) treatment with tyrosine kinase inhibitors (TKIs) focus on efficacy, particularly on molecular response and outcome. In contrast, adverse events (AEs) are often reported as infrequent, minor, tolerable and manageable, but they are increasingly important as therapy is potentially lifelong and multiple TKIs are available. For this reason, the European LeukemiaNet panel for CML management recommendations presents an exhaustive and critical summary of AEs emerging during CML treatment, to assist their understanding, management and prevention. There are five major conclusions. First, the main purpose of CML treatment is the antileukemic effect. Suboptimal management of AEs must not compromise this first objective. Second, most patients will have AEs, usually early, mostly mild to moderate, and which will resolve spontaneously or are easily controlled by simple means. Third, reduction or interruption of treatment must only be done if optimal management of the AE cannot be accomplished in other ways, and frequent monitoring is needed to detect resolution of the AE as early as possible. Fourth, attention must be given to comorbidities and drug interactions, and to new events unrelated to TKIs that are inevitable during such a prolonged treatment. Fifth, some TKI-related AEs have emerged which were not predicted or detected in earlier studies, maybe because of suboptimal attention to or absence from the preclinical data. Overall, imatinib has demonstrated a good long-term safety profile, though recent findings suggest underestimation of symptom severity by physicians. Second and third generation TKIs have shown higher response rates, but have been associated with unexpected problems, some of which could be irreversible. We hope these recommendations will help to minimise adverse events, and we believe that an optimal management of them will be rewarded by better TKI compliance and thus better CML outcomes, together with better quality of life. Nature Publishing Group 2016-08 2016-06-03 /pmc/articles/PMC4991363/ /pubmed/27121688 http://dx.doi.org/10.1038/leu.2016.104 Text en Copyright © 2016 Macmillan Publishers Limited http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Review Steegmann, J L Baccarani, M Breccia, M Casado, L F García-Gutiérrez, V Hochhaus, A Kim, D-W Kim, T D Khoury, H J Le Coutre, P Mayer, J Milojkovic, D Porkka, K Rea, D Rosti, G Saussele, S Hehlmann, R Clark, R E European LeukemiaNet recommendations for the management and avoidance of adverse events of treatment in chronic myeloid leukaemia |
title | European LeukemiaNet recommendations for the management and avoidance of adverse
events of treatment in chronic myeloid leukaemia |
title_full | European LeukemiaNet recommendations for the management and avoidance of adverse
events of treatment in chronic myeloid leukaemia |
title_fullStr | European LeukemiaNet recommendations for the management and avoidance of adverse
events of treatment in chronic myeloid leukaemia |
title_full_unstemmed | European LeukemiaNet recommendations for the management and avoidance of adverse
events of treatment in chronic myeloid leukaemia |
title_short | European LeukemiaNet recommendations for the management and avoidance of adverse
events of treatment in chronic myeloid leukaemia |
title_sort | european leukemianet recommendations for the management and avoidance of adverse
events of treatment in chronic myeloid leukaemia |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991363/ https://www.ncbi.nlm.nih.gov/pubmed/27121688 http://dx.doi.org/10.1038/leu.2016.104 |
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