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Case Study: Does Hemodialysis Reduce Tyrosine Kinase Inhibitor Concentration in CML?

By: Kayci Reyer
Posted: Friday, September 11, 2020

According to a case study published in Internal Medicine (the journal of The Japanese Society of Internal Medicine), patients with chronic myeloid leukemia (CML) who have experienced organ impairment and are being treated with tyrosine kinase inhibitor therapy may benefit from close monitoring of plasma medication concentration levels. Itaru Matsumura, MD, PhD, of Kindai University Hospital, Japan, and colleagues evaluated a patient with CML and liver and renal impairment who was also undergoing hemodialysis.

The patient, aged 64, was experiencing cirrhosis of the liver and had been receiving thrice-weekly hemodialysis since 1985 due to chronic kidney disease. At the initial visit, a bone marrow specimen indicated marked hypercellularity with myeloid hyperplasia, and he was diagnosed with chronic-phase CML. He began receiving 50 mg/day of dasatinib.

One week into dasatinib treatment, plasma concentration levels were measured. The authors reported a concentration of 46.9 ng/mL at a follow-up of 2 hours on a day the patient received treatment prior to hemodialysis and a concentration of 227 ng/mL on the following day when hemodialysis did not occur.

The occurrence of mild bilateral pleural effusion and pulmonary hypertension, due to chronic heart failure and thought to be worsened by dasatinib, led to the treatment’s replacement with 200 mg of bosutinib per day at 2 weeks into treatment. Plasma concentrations were measured 2 hours after administration prior to hemodialysis, during which the concentration had fluctuated severely (85.5 ng/mL to 273 ng/mL), and again on a consecutive day without hemodialysis (180 ng/mL). After conducting additional tests, hemodialysis was found to partially reduce the concentration of bosutinib. Though the dosage remained appropriate for the patient, the authors noted, “it is necessary to measure [tyrosine kinase inhibitor] concentrations in order to optimize such drug treatment.”

Disclosure: For full disclosures of the study authors, visit jstage.jst.go.jp.



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