SOHO 2026 | Adjusting treatment to improve tolerability in patients with CML

It’s a big talk by itself but maybe one important message for patients treating CML, especially our colleagues, whether in academia or in a community setting, we do see a lot of patients who receive any particular TKI or CML drug, and when they have side effects within two/three weeks of therapy, they are changed or switched to another drug. Two/three weeks after, they have another toxicity, switch to another drug. So I think the important point here is that at the initiation of therapy, many patients will develop some sort of side effect. And I think, as CML physicians, we need to try and keep the patients as much as we can on that same drug by doing some adjustments, maybe holding the drug for a little bit and resuming it at a lower dose. And many times we see that resuming the treatment at a lower dose can actually mitigate the risk of side effects and keep the patients on treatment for a longer period of time, so they can achieve remission. And we have shown that with dasatinib, with nilotinib, with bosutinib, even with imatinib. So patients who are having side effects, particularly if they are in a major molecular response or deeper, it is really very safe to reduce the dose. And more than 90% of the patients in some studies were shown to remain in a major molecular response. So I think in patients who develop toxicities, number one, I would reduce the dose, try to keep the patient on the study medication or whatever medication I’m using for a longer period of time, as long as they are achieving remission. If that strategy fails, if the patient continues to have toxicities, then I will need to change to another drug, and then my selection will be primarily based on the safety profile of the drug and the comorbidities of our patient.

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