Side Effects and Sequelae of Treatment for Chronic Myeloid Leukemia in Childhood and Adolescence

Suttorp M, Metzler M (2020)

Publication Type: Authored book

Publication year: 2020

Publisher: Springer International Publishing

ISBN: 9783030491406

Abstract

Targeted therapy by tyrosine kinase inhibitors (TKIs) has dramatically improved survival rates in CML. Today stem cell transplantation is no longer the first-line treatment also in children. However, in the majority of patients, TKIs probably have to be administered over decades to control instead of eradicating completely the malignant cell clone. Thus, CML nowadays has to be regarded in sensu stricto as “chronic” which is in sharp contrast to the other pediatric malignancies dealt with in the context of this book. Lifelong TKI administration requires assessment of any side or “late” effect as a possible “untargeted consequence of a targeted treatment, " which represents a novelty in pediatric oncology. Systematic investigations on TKI late effects in adults are missing, and the cumulative toxicity of ongoing exposure in a growing organism with regard to young and old adulthood is presently hard to be judged on. Side effects so far observed include longitudinal growth impairment, disturbed osseous metabolism, endocrine alterations (hyperparathyroidism, low vitamin D, low growth hormone, altered thyroid metabolism, blood glucose level, impaired fertility), and cardiovascular side effects. Any change in laboratory findings or reported health problems should as causative agent take TKIs into consideration. Most TKIs are substrates and inhibitors of cytochrome P450. If patients are treated with polypharmacy because of TKI side effects or other underlying diseases, drug-drug interactions are always a significant safety concern. While men wanting to become fathers can safely remain on imatinib, women of childbearing potential must be advised on the teratogenic potential of all TKIs. Thus, proper contraception should start early in teenagers. Future strategies including new drugs or vaccination targeting specifically at CML stem cells are currently being explored. First results look promising; however, it seems not unlikely that side effects and late effects may also be associated with these new approaches.

Authors with CRIS profile

Markus Metzler Professur für Kinder- und Jugendmedizin mit dem Schwerpunkt Pädiatrische Onkologie und Hämatologie

Involved external institutions

Technische Universität Dresden

Germany (DE)

How to cite

APA:

Suttorp, M., & Metzler, M. (2020). Side Effects and Sequelae of Treatment for Chronic Myeloid Leukemia in Childhood and Adolescence. Springer International Publishing.

MLA:

Suttorp, Meinolf, and Markus Metzler. Side Effects and Sequelae of Treatment for Chronic Myeloid Leukemia in Childhood and Adolescence. Springer International Publishing, 2020.

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