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What is the most commonly reported side effect of Imatinib or Glivec therapy ?
KH: Low Counts: Many patients (<1% to 46%) experience low blood counts while taking IM due to myelosuppression, the inability of the bone marrow to produce an adequate number of cells. All patients taking IM should have their blood counts monitored closely. Complete blood counts (CBCs) should be monitored weekly in chronic phase patients during the first month of IM treatment. If platelet counts remain over 100,000/mm3 and absolute neutrophil count (ANC) remains over 1,500/mm3, CBC monitoring can be reduced to every two weeks until 12 weeks of IM therapy has been reached. Thereafter, if counts are stable, monitoring may occur monthly or even longer if appropriate. Patients in accelerated or blast crisis should have CBCs performed more often.
Who often experiences low counts and myelosuppression with IM therapy ?
KH:Myelosuppression due to IM therapy is more common in patients with CML in the accelerated or blast crisis stages, but can also occur in chronic phase patients.
How is myelosuppression observed ?
KH: Myelosuppression and low counts are evident by low platelet counts (thrombocytopenia), low absolute neutrophil counts (neutropenia) and/or low red blood cell counts (anemia), usually measured by a decrease in hemoglobin.
What have others done when mild reduction in counts was observed ?
KH: A mild or moderate reduction in counts may require no intervention at all and the counts often recover with continued therapy.
What have been done in cases of extreme reduction ?
KH: In more extreme cases, depending on the type and severity of the myelosuppresion and the phase of CML, a physician may recommend the use of growth factors such as Neupogen (for neutropenia), Neumega (for thrombocytopenia) and Procrit or Aranesp (for anemia); interruption of treatment with IM; or, in some cases, a transfusion. The article referenced below, "Practical Management of Patients with Chronic Myeloid Leukemia Receiving Imatinib," discusses these options in further detail.
Havepatients reported night sweats with IM ?
KH: Night sweats have been reported by patients receiving IM therapy. It is disturbing to many patients because they associate it with worsening of CML as most had reported night sweats just prior their CML diagnosis.
Night sweats should be reported to a physician. As long as one's cytogenetic status and blood counts are stable, there is no cause for alarm. Try sleeping in lighter pajamas or keeping the bedroom cooler.
Reference:
Deininger MW, O'Brien SG, Ford JM, Druker BJ: Practical Management of Patients with Chronic Myeloid Leukemia Receiving Imatinib. Journal of Clinical Oncology, Vol 21 (8):1-11, 2003
CML Prisms--Lit for Asian CML Support Group Member
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How about weight gain on glivec ?
KH: Rapid weight gain is more common in patients treated with interferon prior to initiating IM therapy and is probably due to a renewed appetite after stopping treatment with interferon.
But weight gain has been reported in patients taking IM and may be due, in part, to fluid retention. Rapid weight gain associated with marked fluid retention should be addressed with a doctor.
But all increases in weight should be monitored and may be managed to some extent by diet and exercise.
One of our members, Genie, relates her fight and victory over the glivec weight gain. See her story.
Do patients report feelingdepressed and down with IM therapy ?
KH: Some patients have reported feeling down in the dumps or depressed while receiving IM therapy.
Whether the depression is a result of being diagnosed with CML or is a direct side effect of IM, severe depression can be a serious problem if not treated adequately.
Depression may be helped by exercise, meditation, therapy or, in some cases, antidepressant medication. Of course, one should consult with a doctor and be careful which medications are appropriate to take in conjunction with IM.
Are people reporting foggy and fuzzy thinking with IM ?
KH: Many patients report feeling "foggy" and "fuzzy-headed" while taking IM, especially in the morning.
Some individuals report that exercise helps with this problem.
If the foggy thinking is experienced along with fatigue and symptoms of depression, treatment with antidepressant medication may be helpful. It is important to discuss all medications carefully with a doctor before considering taking an antidepressant.
How about headaches ?
KH: Headache is reported by 28% of patients in clinical trials. Ibuprofen may help symptoms of headache. Also, try reducing stress and increasing exercise. Prolonged or severe headache should be reported immediately to a physician.
Do people get tired easily ?
KH: Fatigue has been reported in 33% of patients in clinical trials and may be associated with anemia (decreased hemoglobin counts) in patients treated with IM. In such cases, the fatigue may be alleviated through treatment of the anemia. In other cases, the fatigue is a more generalized complaint. Some patients have reported an improvement in fatigue levels by increasing their exercise regimen. Others require more rest and sleep.
Have people reported
indigestion ?
.KH: Approximately 19% of patients in clinical trials report indigestion while taking IM. As in the case of nausea, indigestion may be prevented by taking IM with meals and plenty of water. Over-the-counter medications such as antacids may also alleviate the symptoms, but be sure to report this to a physician.
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