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First-Line Use of Second-Generation Tyrosine Kinase Inhibitors in Patients With Chronic Myeloid Leukemia

First-Line Use of Second-Generation Tyrosine Kinase Inhibitors in Patients With Chronic Myeloid Leukemia

Oncology nurses play a pivotal role in monitoring patients with Ph+ CML, from those who are newly diagnosed to others who may have been receiving TKI treatment for years. Indications, dosing, and characteristics of second generation oral TKIs, including potential drug-drug interactions and adverse events, and how best to manage them, are explored in this article.

Case 1: Use of Nilotinib in a Treatment-Naïve Patient

The first of two case studies of representative patients presented to provide an understanding of treatment considerations for Ph+ CML.

Case 2: Switching a Patient to Dasatinib When Imatinib Therapy Fails

The second of two case studies of representative patients presented to provide an understanding of treatment considerations for Ph+ CML.

Case 3: Iron Overload Increasingly is a Concern in Patients with Myelodysplastic Syndrome

Supportive care and symptom management traditionally have been the focus of treatment for patients with myelodysplastic syndrome (MDS). Recent advances in therapeutic modalities, however, have increased the lifespan of patients with MDS, who are now receiving red blood cell transfusions for their chronic anemia, resulting in iron overload. This case looks at a 71-year-old man who received a bone marrow biopsy, which found dysplasia and ringed sideroblasts but no myeloid blasts.

Case 2: In Sickle Cell Disease, Endocrine Dysfunction May Signal Iron Overload

Frequent blood transfusions are necessary in sickle cell disease to manage chronic— often severe—anemia. Chronic transfusions can lead to iron overload, manifestations that may appear indirectly as endocrine function disorders, such as hypothyroidism. Testing, however, can reveal the underlying cause. This study looks at a 32-year-old woman who was diagnosed with chronic anemia due to hemolysis of the sickled red cells.

Case 1: In Betathalassemia, Low Liver Iron Does Not Necessarily Indicate That Cardiac Iron is Not Present

Liver iron has long been thought to be a reliable indicator of total body iron burden, including the likelihood of cardiac iron. In patients with beta-thalassemia, however, that is not always the case. This study looks at a 12-year-old girl of South Asian descent who switched to deferasirox after her tranfser at the thalassemia treatment center.

Nursing Considerations in the Management of Patients with Chronic Transfusional Iron Overload

This article addresses the most common diseases in which iron overload can be problematic: betathalassemia, SCD, and MDS. Discussed are the cellular and molecular mechanisms of iron metabolism; the pathophysiology of beta-thalassemia, SCD, and MDS; the development of chronic transfusional iron overload; signs and symptoms of the condition; monitoring patients; the role of nurses in iron chelation therapy; medications used to treat iron overload; and improving patient management, patient education, and adherence to therapy.

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