Imatinib

INTRODUCTION

Indications

Newly diagnosed Philadelphia positive (Ph+) chronic myeloid leukemia (CML). CML in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alpha treatment. Kit (CD117) positive Metastatic/unresectable malignant gastrointestinal stomal tumors (GIST). Pediatric patients with Ph+ CML after failure of bone marrow transplant or resistance to interferon-alpha. Adult patients with relapsed or refractory Ph+ acute lymphoblastic leukemia (ALL). Myelodysplastic/myeloproliferative disease (MDS/MPD). Aggressive systemic mastocytosis (ASM). Hypereosinophilic syndrome and/or Chronic eosinophilic leukemia (HES/CEL). Unresectable, recurrent, or metastatic Dermatofibrosarcoma protuberans (DFSP).

Action

Inhibits kinases which may be produced by malignant cell lines. Therapeutic Effects: Inhibits production of malignant cell lines with decreased proliferation of leukemic cells in CML, HES/CEL, and ALL and malignant cells in GIST, MDS/MPD, ASM, and DFSP.

Adverse Reactions/Side Effects

CNS: fatigue, headache, weakness. Resp: cough, dyspnea, epistaxis, nasopharyngitis, pneumonia. GI: HEPATOTOXICITY, abdominal pain, anorexia, constipation, diarrhea, dyspepsia, nausea, vomiting. Derm: petechiae, pruritus, skin rash. F and E: edema (including pleural effusion, pericardial infusion, anasarca, superficial edema and fluid retention), hypokalemia. Hemat: BLEEDING, NEUTROPENIA, THROMBOCYTOPENIA. Metab: weight gain. MS: arthralgia, muscle cramps, musculoskeletal pain, myalgia. Misc: fever, night sweats.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician or nursing staff immediately.

• Monitor signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or any other unusual bleeding. Report these signs immediately to the physician or nursing staff.

• Assess any breathing problems or signs of pneumonia such as cough, fever, chills, and chest pain during inspiration and expiration. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor signs of pericardial infusion (chest pain, pressure) or pleural effusion (rales/crackles, decreased breath sounds, pleuritic friction rub, fatigue, dyspnea, tachypnea, cough, wheezing, pleuritic pain, hypoxia). Notify physician of these signs.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor neuromuscular signs of low potassium levels (hypokalemia), including headache, lethargy, weakness, cramping, and ...