Peush Bajpai, (2012) Prospective evaluation of musculoskeletal events in patients of chronic myeloid leukemia–chronic phase treated with Imatinib mesylate and possible correlation with electrolyte imbalances. Masters thesis, Cancer Institute (WIA), Chennai.
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Abstract
INTRODUCTION: Tyrosine Kinase inhibitors especially Imatinib have become the first choice of therapy in Chronic Myeloid Leukemia (CML).The adherence to therapy is an important factor required for achieving Molecular responses. Myalgia and Musculoskeletal pain are one of the common nonhematological toxicities affecting adherence. One of the most common hypothesis for this toxicity stated is Phosphate and calcium metabolism. We have done a prospective study to look into the incidence of Myalgia and Musculoskeletal pain in our patients and also the abnormalities in serum electrolytes and also a possible correlation between the two. PATIENTS AND METHODS: We conducted a prospective observational study between January 2011- December 2012 where all new patients of CML without any relevant comorbids were included. Samples Of serum electrolytes (serum phosphate, sodium, potassium and Calcium (along with Serum Albumin to check on ionized levels) were sent along with a urine spot sample for Creatinine and Phosphate to calculate serum phosphate at 0, 3 and 6th month. 10 control samples were also sent to check for validation. Patients were followed up and hematological responses were recorded at each visit and history for any non hematological adverse effect especially myalgia was documented. Stastical analysis was done using paired t tests using SPSS software version 13 RESULTS: 57 patients were included, median age 32yrs (4-65yrs), 6 pediatric patients were included 92% achieved complete hematological response at the end of first year. Myalgia and Musculoskeletal pain were the most common side effects (31%) next was hypopigmentation (8%). Grd 1 myalgia (68%) was most common. For serum electrolytes a decrease in trend from baseline values for serum Phosphate, Calcium and potassium was observed so also there was fractional increase in phosphate in urine. Correlation did not show any significant relationship between decrease in calcium and phosphate values and myalgia probably because of a small sample size. However decreasing potassium values at 3rd month was having a close correlation (=0.07). Only 1 patient (3%) who had Grd 3 myalgia was non compliant. CONCLUSIONS: Musculoskeletal pain and myalgia are one of the most common nonhematological toxicities on Imatinib although they tend to resolve they tend to be associated with relative hypokalemia and possibly relative hypophosphatemia and hypocalcemia. This probably warrant further study especially in the subset of pediatric and elderly patients where bone growth and bone mineral density might be affected adversely.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | musculoskeletal events, chronic myeloid leukemia–chronic phase. Imatinib mesylate, possible correlation, electrolyte imbalances. |
| Subjects: | MEDICAL > Medical Oncology |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2020 02:15 |
| Last Modified: | 16 Feb 2020 02:07 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11905 |
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