Dear Editor,Tyrosine kinase inhibitors (TKI) are beneficially used for patients with breakpoint cluster region‐abelson (BCR‐ABL) fusion gene‐positive chronic myeloid leukemia (CML); however, elderly patients have a lower tolerance to the standard dose of TKI because of severe adverse events, and therefore a dose reduction or discontinuation of treatment is often required. Recently, low‐dose dasatinib (a dose as low as 20 mg/day) has been shown to be more effective than low‐dose imatinib. We have also reported a similar finding in an elderly chronic phase CML (CML‐CP) patient receiving low‐dose dasatinib (mean dose 5.7 mg/day). In the case of low‐dose therapy, a study of pharmacokinetics and pharmacodynamics is useful to determine the appropriate dosing for a preferable effect without severe adverse events. Although routine monitoring of the therapeutic plasma concentration should be carried out specifically in treatment‐resistant cases for avoiding unnecessary dose escalation, this can also be applied to patients who cannot receive the standard dose because of adverse events. It is controversial whether the trough or the peak concentration relates to a better outcome in the case of imatinib therapy. Regarding dasatinib, this kind of study was limited, and analysis of the intracellular concentration was also shown to be important
Geriatrics & Gerontology International – Wiley
Published: Jan 1, 2018
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