{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T14:07:43Z","timestamp":1744207663701},"reference-count":39,"publisher":"Wiley","issue":"9-10","license":[{"start":{"date-parts":[[2010,3,16]],"date-time":"2010-03-16T00:00:00Z","timestamp":1268697600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Clinical Nursing"],"published-print":{"date-parts":[[2010,5]]},"abstract":"<jats:p><jats:bold>Aims and objectives.\u2002<\/jats:bold> To review the use of second\u2010line tyrosine kinase inhibitors in patients with chronic myeloid leukaemia (CML) and provide recommendations for managing adverse events (AEs) to maximise patient benefit.<\/jats:p><jats:p><jats:bold>Background.\u2002<\/jats:bold> Treatment of CML has been revolutionised with the advent of tyrosine kinase inhibitors (TKIs) that target the breakpoint cluster region\u2010Abelson (BCR\u2010ABL) kinase. Imatinib is the only first\u2010line TKI currently available for the treatment of CML; however, intolerance and resistance remain significant clinical challenges. The approved second\u2010line treatment options for CML are dasatinib, nilotinib or escalated\u2010dose imatinib.<\/jats:p><jats:p><jats:bold>Design.\u2002<\/jats:bold> Review article.<\/jats:p><jats:p><jats:bold>Methods.\u2002<\/jats:bold> Searches of PubMed, ASCO and ASH electronic databases for relevant search terms were performed between July 2008\u2013January 2009.<\/jats:p><jats:p><jats:bold>Findings.\u2002<\/jats:bold> Dasatinib has no cross\u2010intolerance with imatinib, and the most frequent AEs (cytopenias and pleural and pericardial effusions) can generally be managed by dose interruption and reduction. Nilotinib has a high degree of haematologic cross\u2010intolerance with first\u2010line imatinib. As might be expected, high\u2010dose imatinib has the potential for more severe AEs than standard\u2010dose imatinib.<\/jats:p><jats:p><jats:bold>Conclusions.\u2002<\/jats:bold> There are known safety issues inherent to each TKI and close monitoring by nursing staff is necessary to identify and effectively manage AEs.<\/jats:p><jats:p><jats:bold>Relevance to clinical practice.\u2002<\/jats:bold> All three TKIs have demonstrated potential for fluid retention and cardiotoxicity. Nurses should be aware of how these AEs manifest and intervene appropriately. The safety profiles of these TKIs clearly differs and it is important to consider factors such as comorbidities when making treatment decisions.<\/jats:p>","DOI":"10.1111\/j.1365-2702.2009.03167.x","type":"journal-article","created":{"date-parts":[[2010,3,16]],"date-time":"2010-03-16T11:03:00Z","timestamp":1268737380000},"page":"1207-1218","source":"Crossref","is-referenced-by-count":6,"title":["Safety profiles of second\u2010line tyrosine kinase inhibitors in patients with chronic myeloid leukaemia"],"prefix":"10.1111","volume":"19","author":[{"given":"Sara M","family":"Tinsley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,4,8]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2007-01-070144"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/306277a0"},{"key":"e_1_2_12_4_1","volume-title":"SPRYCEL\u00ae (dasatinib) Prescribing Information","author":"Bristol\u2010Myers Squibb Company","year":"2009"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(96)00061-7"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-09-046888"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"315a","DOI":"10.1182\/blood.V110.11.1040.1040","article-title":"Nilotinib is associated with minimal cross intolerance to imatinib in patients with imatinib\u2010intolerant Philadelphia\u2010positive (Ph+) chronic myelogenous leukemia (CML) in either chronic phase (CP) or accelerated phase (AP)","volume":"110","author":"Cortes J","year":"2007","journal-title":"Blood"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200104053441402"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa062867"},{"key":"e_1_2_12_10_1","doi-asserted-by":"crossref","DOI":"10.1182\/blood.V110.11.4582.4582","article-title":"In vitro cardiotoxicity potential comparative assessments of chronic myelogenous leukemia tyrosine kinase inhibitor therapies: dasatinib, imatinib and nilotinib","volume":"110","author":"Freebern WJ","year":"2007","journal-title":"Blood"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1188\/09.CJON.329-335"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0092-8674(84)90077-1"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-09-046839"},{"issue":"18","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"7045","DOI":"10.1200\/jco.2007.25.18_suppl.7045","article-title":"Discontinuation and dose modification of imatinib in clinical practice","volume":"25","author":"Hamdan MY","year":"2007","journal-title":"Journal of Clinical Oncology"},{"key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"15a","DOI":"10.1182\/blood.V110.11.25.25","article-title":"IRIS 6\u2010year follow\u2010up: sustained survival and declining annual rate of transformation in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML\u2010CP) treated with imatinib","volume":"110","author":"Hochhaus A","year":"2007","journal-title":"Blood"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-09-047266"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2008.84"},{"key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"313a","DOI":"10.1182\/blood.V110.11.1035.1035","article-title":"Impact of imatinib mesylate dose escalation on resistance and sub\u2010optimal responses to standard\u2010dose therapy in patients (pts) with chronic myeloid leukemia (CML)","volume":"110","author":"Jabbour E","year":"2007","journal-title":"Blood"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-05-1451"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-11-056028"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2007-03-080689"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2007-03-080689"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1021\/jm049486a"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.2408149"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2003-06-2042"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2008.26.15_suppl.7009"},{"key":"e_1_2_12_27_1","unstructured":"National Comprehensive Cancer Network(2008)Clinical Practice Guidelines in OncologyTM: chronic myelogenous leukemia V.1.2008. 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