Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 61-67

Therapeutic drug monitoring of imatinib in patients of chronic myeloid leukemia – Chronic phase

1 Department of Clinical hematology, Medical Division, Command Hospital Air Force, Bengaluru, Karnataka, India
2 Department of Biochemistry, Armed Forces Medical College, Pune, Maharashtra, India
3 Department of Obstetrics and Gynaecology, Command Hospital Air Force, Bengaluru, Karnataka, India
4 Department of Endocrinology, Medical Divison Command hospital Air Force, Bengaluru, Karnataka, India
5 Department of Nephrology, Medical Divison Command hospital Air Force, Bengaluru, Karnataka, India

Correspondence Address:
Vijoy Kumar Jha
Command Hospital Air Force, Bengaluru - 560 007, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpp.jpp_28_21

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Introduction: Tyrosine kinase inhibitor is recommended for the initial management of chronic phase chronic myeloid leukemia (CP CML) based on the more favorable balance of toxicity and long-term disease control. Background: Mean trough plasma Imatinib Mesylate (IM) levels are detected to be significantly higher in patients with a complete cytogenetic response or major molecular response (MMR). Methodology: The primary objective of the study was to correlate the IM drug levels with MMR on two different occasions at least 3 months apart and to study the variation in the plasma trough levels of IM during the treatment with standard dose for at least 12 months. Results: After exclusion, 30 patients of CML-CP in MMR, on standard dose over a period of 2 years were finally analyzed. The mean IM plasma levels (IPLs) of the first sample for all patients were 1722 ± 566 ng/ml (IPL-1) with a corresponding mean molecular response (MR) 0.0257 ± 0.0279 breakpoint cluster region-abelson murine leukemia (BCR-ABL) IS % (MR-1). The mean IPLs of the second sample for all patients were 1549 ± 375 ng/ml (IPL-2) with a corresponding mean MR 0.0143 ± 0.0184 BCR-ABL IS % (MR-2). Area under the receiver operating characteristic curve for IPL-1 was 0.565 and IPL-2 was 0.639. For IM level at second point of 1800 ng/ml, the specificity for predicting MMR was 81.8% and sensitivity was 31.6%. Conclusion: Monitoring of trough IM plasma concentrations may become the part of standard management of CML patients.

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