Researchers at Baylor College of Medicine and The University of Texas MD Anderson Cancer Center recently published in the journal Cancer findings that therapies based on tyrosine kinase inhibitors (TKIs) seem to be relatively safe in terms of kidney function in patients with chronic myeloid leukemia (CML). The study is entitled “Estimated glomerular filtration rate changes in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors”.
CML is a type of cancer that affects immature myeloid cells in the bone marrow. These are important cells as they are responsible for the generation of red blood cells, most type of white blood cells, and platelets. TKI drugs are widely used in the treatment of CML, including imatinib, nilotinib, dasatinib and bosutinib. TKIs are usually well-tolerated; however, chronic use of these drugs can lead to some off-target effects. One of the adverse effects reported is acute kidney injury and chronic kidney disease (CKD).
CKD is a medical condition characterized by the gradual loss of kidney function over time that can eventually lead to kidney failure, a situation in which the patient will have to undergo either dialysis or a kidney transplant. CKD can be caused by disorders like diabetes or high blood pressure, and is associated with an increased risk of cardiovascular diseases. It is estimated that 26 million American adults suffer from the disease.
In the study, researchers assessed the impact of TKI treatment on kidney function and the incidence of acute kidney injury and CKD in 468 CML patients who had been treated with imatinib, dasatinib and nilotinib as initial therapy. Several parameters were analyzed including the glomerular filtration rate (GFR; the best test to measure kidney function) from the start of the treatment to a median follow-up of 52 months.
Researchers found that 4% of the patients (19) in the cohort developed acute kidney injury due to TKI therapy. Among the drugs analyzed, imatinib was found to be associated with a higher incidence of acute kidney injury when compared to dasatinib and nilotinib. A total of 14% of the patients (58) developed CKD during TKI treatment, from which 84% (49 patients) were under treatment with imatinib. All three drugs were found to have a positive effect on kidney function, with nilotinib promoting a modest but significant increase in the mean GFR after a 3-month treatment. Interestingly, in patients with no CKD at baseline, imatinib was found to reduce GFR over time. The team found that neither acute kidney injury nor CKD had a significant impact on CML patient’s response rates or survival.
Apart from TKI use (especially imatinib), researchers also reported that age, hypertension and diabetes mellitus were factors that contributed to the development of CKD.
The research team concluded that the use of TKI therapies may be considered safe concerning CKD in CML patients; however, the authors advise a close patient monitoring.