Medical Information

Dasatinib is a tyrosine kinase inhibitor primarily used for the treatment of hematological malignancies with specific gene mutations. Its use requires strict monitoring of hematological toxicity and cardiovascular risk. The following will explain the management requirements for bone marrow suppression and QT interval prolongation from two aspects: indication classification and core precautions.

1. Indications

(1) Philadelphia chromosome positive chronic myeloid leukemia (Ph+CML): suitable for the treatment of adult chronic, accelerated, or rapidly changing phases.

(2) Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ALL): Used for adult patients who are resistant or intolerant to previous treatments.

2. Medication precautions

(1) Hematological toxicity

During the initial stage of treatment, it is necessary to monitor the whole blood cell count weekly. If there is a grade 3-4 neutropenia or thrombocytopenia, the medication should be suspended, and the dosage should be reduced after recovery.

(2) Cardiovascular risk

May cause QT interval prolongation, it is necessary to correct hypokalemia/magnesemia before medication, regularly monitor electrocardiogram, and avoid using drugs that prolong QT interval in combination.

(3) Fluid retention

Including pleural effusion and pericardial effusion, it is recommended to monitor body weight and respiratory symptoms, and in severe cases, diuretic treatment or suspension of medication may be necessary.

(4) Hepatotoxicity

During the treatment period, liver function should be monitored monthly. If the transaminase level increases by more than 5 times the ULN, treatment should be interrupted, and the dosage should be reduced and continued after recovery.

(5) Drug interactions

Strong CYP3A4 inhibitors should be avoided in combination, and when used in combination, the dose of dasatinib should be reduced to 40mg/day; Inducing agents may reduce therapeutic efficacy.