Systematic review of clinical trials and prospective cohorts: follow up methods in patients with chronic myeloid leukemia treated with dasatinib

Abstract

Chronic myeloid leukemia (CML) is a malignancy of hematopoietic stem cells associated with a t(9;22) translocation that forms the Philadelphia chromosome and creates a novel fusion gene, BCR-ABL. For those who are resistant or intolerant to imatinib, secondgeneration tirosino-kinase inhibitor, as dasatinib, has been shown to be efficacious in all phases of the disease. Once dasatinib is taken orally and the treatment has no defined end point, a complete follow up method, including a pharmacotherapy follow up, to monitor the CML patients is essential to define adherence and treatment safety. To systematically review follow up methods of CML patients treated with dasatinib in clinical trials (CT) either randomized (RCT), or not (NRCT) and prospective cohorts (PC) a sensitized research was performed on the databases Medline (Pubmed), Cochrane Library (OVID), Embase (Elsevier) and Lilacs. Four RCT, four NRCT and three PC were identified and contained data about patients follow up, which proved to be well established and structured. Adverse drug reactions grades III and IV description was in accordance with the already published data. No pharmacotherapy follow up method has been identified, neither in CT nor in PC. The implementation of a patients follow up method is crucial to qualify the assistance and standardize the conducts. And with the presence of a pharmacist and a pharmacotherapy follow up method must be incorporated in this new role of long-term CML treatment with dasatinib in order to rationalize resources, increase the treatment efficacy and safety and improve the adherence and patient life’s quality.