Management of drug toxicities in chronic myeloid leukaemia

Therapy for patients with chronic myeloid leukaemia has grown in complexity, first with the advent of the prototype ABL kinase inhibitor, imatinib, and subsequently with the availability of alternate (currently second-line) inhibitors. Imatinib, dasatinib and nilotinib each have specific considerations regarding safety and toxicity, in addition to a limited number common to the class of ABL kinase inhibitors. Optimal management of patients on therapy requires intimate knowledge not only of response criteria and of timing but also of potential toxicities and their basis, best approaches to avoid them, strategies to manage them when identified and how they may affect response to therapy and patient outcome. With the availability of several approved kinase inhibitors and the ongoing development of additional therapies for Philadelphia chromosome positive (Ph+) leukaemias, there is increasing incorporation of toxicity considerations into decision making between agents. This article reviews the toxicities related to the currently available ABL inhibitors - their basis, relevance and management.