Key result
Imatinib was significantly linked to renal adverse events compared to other TKIs, while dasatinib was associated with nephrotic syndrome and nilotinib with tumor lysis syndrome-related kidney injury.
Why the study?
Renal adverse drug reactions associated with TKIs in CML are relatively rare, and there is currently no standardized protocol for their management.
Do tyrosine kinase inhibitors cause specific renal adverse drug reactions in patients with chronic myeloid leukemia?
Systematic Review
Do tyrosine kinase inhibitors cause specific renal adverse drug reactions in patients with chronic myeloid leukemia?
Different tyrosine kinase inhibitors used in chronic myeloid leukemia have distinct renal adverse effect profiles, necessitating specific monitoring strategies such as eGFR tracking for imatinib and proteinuria assessment for dasatinib.
Supports tailored renal monitoring by TKI in CML; extends evidence for agent-specific adverse effect profiles.
BACKGROUND: Renal adverse drug reactions (ADRs) associated with tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) are relatively rare, and there is currently no standardized protocol for their management. Therefore, this study aimed to summarize renal ADRs related to TKIs use in CML and propose an evidence-based approach to monitor and manage these ADRs. METHODS: A systematic literature review was performed to identify renal ADRs associated with TKIs in CML. Two authors screened the search results and extracted data from 37 eligible studies. These findings were then used to develop a scheme for clinicians to monitor and manage these ADRs. RESULTS: Overall, imatinib seemed to be significantly linked to renal adverse events compared to other TKIs, and switching to dasatinib or nilotinib significantly improved renal function. Similar events were reported with bosutinib, although they were not statistically significant. However, most of the renal events reported on dasatinib were described as nephrotic syndrome that resolved with switching to imatinib. Few cases were reported with nilotinib that described tumor lysis syndrome (TLS)-related kidney injury. CONCLUSIONS: Recommendations include monitoring for progressive decline in the estimated glomerular filtration rate with imatinib, nephrotic syndrome with dasatinib, and TLS with nilotinib. Additionally, holding the offending TKI and managing renal ADRs according to local guidelines were adopted more frequently than reducing the TKI dose.
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Benkhadra et al. (2024) conducted a systematic review in Chronic Myeloid Leukemia. Tyrosine kinase inhibitors vs. Other TKIs was evaluated on Renal adverse drug reactions. Imatinib was significantly linked to renal adverse events compared to other TKIs, while dasatinib was associated with nephrotic syndrome and nilotinib with tumor lysis syndrome-related kidney injury.
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