Protocols - Hemorio

• Decreased Imatinib: Dexametasone, Phenitoin, Carbamazepin, Rifampicin, Phenobarbital, St.
John’s wort
• Changing the concentration of other substances: Cyclosporin, calcium channel blockers,
Metoprolol, contraceptives, statins, warfarin, and paracetamol
HANDLING ADVERSE EFFECTS:
• Intolerance to medication
- Nausea - Symptomatic, take it with a full glass of water, take it before going to bed, or
after a light meal
- Rash – If mild, evaluate anti-histaminic and corticoid. Do not suspend Imatinib. If severe,
suspend Imatinib, treat it as allergic reaction.
- Diarrhea - Antispasmodic
• Liquid retention
- Decrease the volume of liquids ingested
- Use of Diuretics: Hydrochlorothiazide, Furosemide
• Progression to Neutropenia
- Use of GCSF 1 to 3 times/week, if neutrophils < 1000/mm 3 – avoid reduction and even
suspension of Imatinib
• Progression to Anemia
- 8000U to 24.000U per week, if hemoglobin < 10g/dl - avoid reduction and even
suspension of Imatinib
• Progression to Thrombocytopenia
- Try not to suspend. Below 50.000/mm 3 , suspend and re-evaluate in 15 days. Try and
keep the dose. In case it is not possible, reduce to 300mg.
PATIENTS INTOLERANT OR NOT RESPONDING TO IMATINIBE:
• Evaluate possibility of allogeneic TMO, in case of donor, as soon as possible (discuss the
possibility with the patient)
• Evaluate possibility to enroll Nilotinib or Dasatinib use in clinical trials
• Maintain hematological control with hydroxiurea or Aracytin
105