Management of chronic myeloid leukemia with tyrosine kinase inhibitors: adverse events, toxicities and therapy dosing

Targeted therapies have made a near-normal lifespan an attainable goal for many patients with chronic phase chronic myeloid leukemia. Most patients require years of therapy and not everyone may be able to discontinue treatment permanently without recurrence of the leukemia. BCR::ABL1 targeted tyrosine kinase inhibitors, including ATP binding site and allosteric inhibitors that bind to the myristoyl pocket, are associated with treatment-emergent adverse events that may compromise quality of life and well-being. Although alternative treatment options exist, side effects may persist, or new ones occur after a therapy switch. Using a case-based approach, this review examines the incidence of non-hematologic and hematologic treatment-emergent adverse events with specific therapies, provides guidance on adverse event management, and describes the impact of therapy dose reduction on efficacy and tolerability.