Occurrence and current management of side effects in chronic myeloid leukemia patients treated frontline with tyrosine kinase inhibitors

Tyrosine kinase inhibitors (TKIs) represent the gold standard therapy of chronic myeloid leukemia and, after being used in imatinib resistant patients, dasatinib and nilotinib are now also used in frontline. In this article, we review data about occurrence of side effects in several trials testing imatinib or second-generation tyrosine kinase inhibitors first line. Literature data about high-dose imatinib used front-line as single treatment or with different combinations is also examined. A literature search for relevant studies was undertaken mainly in PubMed. This review is aimed to summarize the safety of different treatments and to discuss the current management of most common side effects. Literature evidence supports the fact that side effects associated to TKIs seem to differ between agents, but most of side effects reported occur early within the treatment course. Second generation frontline TKIs reduce the incidence of most of side effects reported with imatinib and peculiar events observed are typically manageable through drug dose reduction or treatment interruption.