more on the management of myelosuppression

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http://www.mdanderson.org/publications/insights/

Here's an exerpt:

During the course of treatment with imatinib and other tyrosine

kinase inhibitors, 30% to 50% of patients develop grade 3 or 4

anemia, thrombocytopenia or neutropenia. Cytopenias most frequently

occur during the first 2 to 3 months of therapy and in many

instances they do not recur. This early myelosuppression is managed

with a temporary treatment interruption if there is grade ¡Ý3

neutropenia (absolute neutrophil count <1 x 109/L) or

thrombocytopenia (platelets <50 x 109/L). Upon recovery, the

tyrosine kinase is restarted at the same dose if counts recover

within 2 weeks or at a lower dose if recovery takes > 2 weeks.9 For

the occasional patient with prolonged and recurrent grade 3

myelosuppression, hematopoietic growth factors have been used.

Filgrastim (G-CSF) has been reported to improve the neutropenia

allowing uninterrupted therapy with imatinib and frequently

improving response to therapy.10 For patients with thrombocytopenia,

low dose interleukin-11 (10 mcg/kg, 3-5 times per week) has been

reported to improve the platelet count, allow continuation of

therapy sometimes with dose escalation, and improve response in some

patients.11 Erythropoietin and darbepoetin have also been reported

to improve anemia associated with tyrosine kinase therapy.12 These

are all investigational uses of these growth factors. Ongoing and

future studies for management of imatinib-associated

myelosuppression at MDACC include:

1) Low-dose interleukin-11 for patient with recurrent or persistent

thrombocytopenia while on imatinib therapy.

2) A study of erythropoietin for imatinib-associated anemia will

start in the near future.

For additional information on studies for management of imatinib-

associated myelosuppression please contact Dr. Cortes or any

other leukemia physician.