Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California Medical Center, 1441 Eastlake Ave Suite 7317, Los Angeles, CA 90033, USA.
J Hematol Oncol. 2009 Nov 12;2:46. doi: 10.1186/1756-8722-2-46.
Tyrosine kinase inhibitors (TKIs) like dasatinib and nilotinib are indicated as second-line treatment for chronic myeloid leukemia resistant or intolerant to the current first-line TKI imatinib. These are agents are well tolerated, but potent and as such should be monitored for potentially serious side-effects like fluid retention and pleural effusions. Here we present key clinical trial data and safety considerations for all FDA approved TKIs in context for effective management of fluid retention and pleural effusions. Altering the dasatinib regimen from 70 mg twice daily to 100 mg daily reduces the risk of pleural effusion for patients taking dasatinib. Should pleural effusion develop, dasatinib should be interrupted until the condition resolves. Patients with a history of pleural effusion risk factors should be monitored closely while taking dasatinib. Patients receiving imatinib and nilotinib are not without risk of fluid retention. All patients should also be educated to recognize and report key symptoms of fluid retention or pleural effusion. Pleural effusions are generally managed by dose interruption/reduction and other supportive measures in patients with chronic myeloid leukemia receiving dasatinib therapy.
酪氨酸激酶抑制剂（TKIs），如达沙替尼和尼洛替尼，适用于对当前一线 TKI 伊马替尼耐药或不耐受的慢性髓性白血病的二线治疗。这些药物耐受性良好，但作用较强，因此应监测可能出现的严重副作用，如体液潴留和胸腔积液。在这里，我们根据有效管理体液潴留和胸腔积液的情况，介绍了所有获得 FDA 批准的 TKI 的关键临床试验数据和安全性考虑因素。将达沙替尼的治疗方案从每日两次 70mg 改为每日 100mg，可以降低接受达沙替尼治疗的患者发生胸腔积液的风险。如果出现胸腔积液，应中断达沙替尼治疗，直至病情缓解。有胸腔积液风险因素病史的患者在服用达沙替尼时应密切监测。接受伊马替尼和尼洛替尼治疗的患者也有发生体液潴留的风险。所有患者还应接受教育，以识别和报告体液潴留或胸腔积液的关键症状。胸腔积液通常通过中断/减少剂量和其他支持性措施来管理，适用于接受达沙替尼治疗的慢性髓性白血病患者。
