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Adverse cutaneous reactions to imatinib (STI571) in Philadelphia chromosome-positive leukemias: A prospective study of 54 patients,☆☆,,★★

A portion of these data was presented at Journées Dermatologiques de Paris, December 2001.
https://doi.org/10.1067/mjd.2003.44Get rights and content

Abstract

Background: Imatinib is a new major treatment in chronic myeloid leukemia. Objective: To study the cutaneous reactions induced by imatinib. Methods: All inpatients and outpatients with Philadelphia chromosome-positive leukemia treated by imatinib were included in this prospective study. Clinical features, pathologic findings, evolution of each case, and analysis of potential risk factors were recorded. Results: A total of 54 patients were included, 48 of whom experienced at least 1 cutaneous reaction. These reactions consisted of 36 rashes, 35 edemas, and 22 pruritus. The rash was severe in 5 patients, resulting in temporary interruption of treatment in 3. Highly significant relationships were observed between the daily dose of imatinib and both rashes and edema. In a multivariate analysis, female sex and the daily dose of imatinib were independent risk factors for the development of rashes. Conclusion: Adverse cutaneous reactions induced by imatinib are frequent, generally moderate, and dose-dependent. (J Am Acad Dermatol 2003;48:201-6.)

Section snippets

Patients

During a 2-month period, from May to June 2001, all consecutive patients previously included in 3 phase 2 trials of imatinib and treated at our institution as inpatients or outpatients were included in this dermatologic study. Patients more than 18 years of age were referred for the treatment of CML or Ph1-positive ALL. In the different protocols, patients had failed to respond to, had relapsed on, or had major side effects while receiving IFN. Patients who had progressed to accelerated phase

Patients

A total of 54 patients (31 males and 23 females) were included in our study. All but 2 patients had CML. The major reasons for including patients in the imatinib trials were hematologic resistance or relapse while receiving IFN (26 of 52). The mean duration of the hematologic malignancy was 46.6 month (± 37.9 SD), ranging from 2.5 to 192 months. Imatinib was administered for a mean of 4.5 months (± 2.9 SD) at an initial dose of 400 or 600 mg/d, according to stage of disease. The daily dose at

Discussion

The purpose of this study was to define the prevalence and the clinical and pathologic patterns of adverse cutaneous reactions induced by imatinib. This molecule selectively inhibits the enzymatic activity of several TKs including the TK associated with BCR-ABL, the receptor of platelet-derived growth factor and c-kit.

In patients with Ph1-positive leukemias, the use of imatinib was associated with a high rate of adverse cutaneous reactions. Rash and edema were the most common adverse effects

Acknowledgements

We are indebted to P. Wolkenstein and John Ford for their helpful review of the manuscript.

References (20)

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Funding sources: None.

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Conflict of interest: None identified.

Reprint requests: Jean Revuz, MD, Department of Dermatology, Henri Mondor Hospital, F-94010 Créteil Cedex, France. E-mail: [email protected].

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0190-9622/2003/$30.00 + 0

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