leukemia symptoms : induced generalized hypopigmentation in patients with chronic myeloid leukemia
Imatinib mesylate (STI-571) is a recently developed oral anticancer agent rationally designed to selectively inhibit certain protein kinases implicated in the pathogenesis of chronic myeloid leukemia (CML) and malignant gastrointestinal stromal tumors.[1] Imatinib mesylate inhibits the bcr-abl tyrosine kinase, thus blocking proliferation and growth of tumor cells expressing bcr-abl. It is generally well tolerated and most side effects are mild to moderate in severity. The common side effects are edema, nausea, vomiting, diarrhea, muscle cramps, and cutaneous reactions. Serious side effects such as hepatotoxicity and myelosuppression also occur, warranting regular monitoring and interruption of treatment.[2] The common dermatological side effects are periorbital edema and dermatitis. Facial edema, pruritis, erythema, dry skin, alopecia, night sweats, and photosensitivity reactions are infrequently reported.[3] We are highlighting an interesting dermatological effect, generalized hypopigmentation, as a result of imatinib therapy, noticeable especially in Indian population because of the dark complexion.
A retrospective analysis of 15 patients of CML on imatinib mesylate between Sept 2003 and Sept 2004 was carried out. Imatinib mesylate was started as first-line therapy in five patients. In the remaining 10 patients, the drug was initiated when therapy with hydroxyurea and interferon did not show evidence of hematologic and cytogenetic response. Imatinib mesylate was initiated during the chronic phase of CML in eleven, accelerated phase in one, and blast crisis in three patients. The dose of imatinib was 400 mg/day in the chronic phase and 600 mg/day in the accelerated and blast crisis phases.
After initiation of the drug, patients were followed weekly for 1 month and thereafter every 2 weeks for an average of 15 months (range: 8-23 months). No patient was lost to follow up. During each visit, patients were assessed for constitutional symptoms, weight gain, periorbital edema, jaundice, vomiting, and diarrhea. Hemogram was done during each visit and liver function tests were done monthly. Bone marrow aspiration was done after 6 months of initiation of drug to assess the cytogenetic response. Complete hematological response was defined as disappearance of signs and symptoms of disease, no splenomegaly, and normal blood counts (TLC < 11000/mm3, platelet count< 450000/mm3, and no immature white blood cells in smear). Cytogenetic responses were classified into major and minor responses. The major response was further classified as complete (0% Philadelphia [Ph] chromosome) and partial (0-34% Ph chromosome). Minor response was defined as presence of Ph chromosome in 35-90% of metaphases.
Indian Journal of Pharmacology, Jan-Feb, 2006 by Sunita, D. Gupta, S. Saluja, S. Bhasin, M. Sharma
A retrospective analysis of 15 patients of CML on imatinib mesylate between Sept 2003 and Sept 2004 was carried out. Imatinib mesylate was started as first-line therapy in five patients. In the remaining 10 patients, the drug was initiated when therapy with hydroxyurea and interferon did not show evidence of hematologic and cytogenetic response. Imatinib mesylate was initiated during the chronic phase of CML in eleven, accelerated phase in one, and blast crisis in three patients. The dose of imatinib was 400 mg/day in the chronic phase and 600 mg/day in the accelerated and blast crisis phases.
After initiation of the drug, patients were followed weekly for 1 month and thereafter every 2 weeks for an average of 15 months (range: 8-23 months). No patient was lost to follow up. During each visit, patients were assessed for constitutional symptoms, weight gain, periorbital edema, jaundice, vomiting, and diarrhea. Hemogram was done during each visit and liver function tests were done monthly. Bone marrow aspiration was done after 6 months of initiation of drug to assess the cytogenetic response. Complete hematological response was defined as disappearance of signs and symptoms of disease, no splenomegaly, and normal blood counts (TLC < 11000/mm3, platelet count< 450000/mm3, and no immature white blood cells in smear). Cytogenetic responses were classified into major and minor responses. The major response was further classified as complete (0% Philadelphia [Ph] chromosome) and partial (0-34% Ph chromosome). Minor response was defined as presence of Ph chromosome in 35-90% of metaphases.
Indian Journal of Pharmacology, Jan-Feb, 2006 by Sunita, D. Gupta, S. Saluja, S. Bhasin, M. Sharma
