Opportunities of Chronic Myeloid Leukemia Treatment with Reduced Doses of Tyrosine Kinase Inhibitors

MA Guryanova, EYu Chelysheva, AG Turkina

National Research Center for Hematology, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Margarita Anatolevna Guryanova, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; Tel.: +7(985)201-70-40; e-mail: margarita.samtcova@yandex.ru

For citation: Guryanova MA, Chelysheva EYu, Turkina AG. Opportunities of Chronic Myeloid Leukemia Treatment with Reduced Doses of Tyrosine Kinase Inhibitors. Clinical oncohematology. 2021;14(1):118–28. (In Russ).

DOI: 10.21320/2500-2139-2021-14-1-118-128


ABSTRACT

Tyrosine kinase inhibitor (TKI) therapy results in deep molecular response (MR) in 60–70 % of chronic myeloid leukemia (CML) patients. However, despite high efficacy of TKIs, many patients experience drug toxicity during the treatment. According to clinical studies, the probability of sustaining off-treatment remission in CML patients with deep MR is about 40–60 %. Great attention has recently been paid to personalized therapy of chronic phase CML. It consists in TKI dose modification to reduce or prevent adverse events. Major retrospective studies proved that in patients with optimal response TKI reduced doses can be considered safe from the point of view of sustaining major and deep MRs achieved with standard TKI doses. Also, prospective clinical trials deal with the follow-up using TKI reduced doses as pre-withdrawal period. But up to now, the results of only 4 of such studies have been available. To take a closer look at long-term follow-up of CML patients receiving reduced doses of TKIs, prospective clinical trials need to be carried out. The present article reviews the results of main studies dealing with management of CML patients treated with TKI reduced doses.

Keywords: chronic myeloid leukemia, tyrosine kinase inhibitors, major molecular response, deep molecular response, adverse events, pharmacokinetics of tyrosine kinase inhibitors.

Received: August 3, 2020

Accepted: November 20, 2020

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Статистика Plumx английский

REFERENCES

  1. Туркина А.Г., Новицкая Н.В., Голенков А.К. идр. Регистр больных хроническим миелолейкозом в Российской Федерации: от наблюдательного исследования к оценке эффективности терапии в клинической практике. Клиническая онкогематология. 2017;10(3):390–401. doi: 10.21320/2500-2139-2017-10-3-390-401.
    [Turkina AG, Novitskaya NV, Golenkov AK, et al. Chronic Myeloid Leukemia Patient Registry in the Russian Federation: From Observational Studies to the Efficacy Evaluation in Clinical Practice. Clinical oncohematology. 2017;10(3):390–401. doi: 10.21320/2500-2139-2017-10-3-390-401. (In Russ)]
  2. Sasaki K, Strom SS, O’Brien S, et al. Relative survival in patients with chronic-phase chronic myeloid leukaemia in the tyrosine-kinase inhibitor era: analysis of patient data from six prospective clinical trials. Lancet Haematol. 2015;2(5):e186–е193. doi: 10.1016/S2352-3026(15)00048-4.
  3. Hehlmann R, Lauseker M, Saussele S, et al. Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia. 2017;31(11):2398–406. doi: 10.1038/leu.2017.253.
  4. Saussele S, Richter J, Guilhot J, et al. Discontinuation of tyrosine kinase inhibitor therapy in chronic myeloid leukaemia (EURO-SKI): a prespecified interim analysis of a prospective, multicentre, non-randomised, trial. Lancet Oncol. 2018;19(6):747–57. doi: 10.1016/S1470-2045(18)30192-X.
  5. Etienne G, Guilhot J, Rea D, et al. Long-term follow-up of the French Stop Imatinib (STIM1) study in patients with chronic myeloid leukemia. J Clin Oncol. 2017;35(3):298–305. doi: 10.1200/jco.2016.68.2914.
  6. Rea D, Nicolini FE, Tulliez M, et al. Discontinuation of dasatinib or nilotinib in chronic myeloid leukemia: interim analysis of the STOP 2G-TKI study. Blood. 2017;129(7):846–54. doi: 10.1182/blood-2016-09-742205.
  7. Chelysheva EYu, Petrova AN, Shukhov OA, et al. First interim analysis of the Russian multicenter prospective study RU-SKI: discontinuation of tyrosine kinase inhibitors in patients with chronic myeloid leukemia and deep molecular response. Hemasphere. 2018;2(S1):141.
  8. Туркина А.Г., Челышева Е.Ю., Шуваев В.А. и др. Результаты наблюдения больных хроническим миелолейкозом с глубоким молекулярным ответом без терапии ингибиторами тирозинкиназ. Терапевтический архив. 2017;89(12):86–96. doi: 10.17116/terarkh2017891286-96.
    [Turkina AG, Chelysheva EYu, Shuvaev VA, et al. Results of following up patients with chronic myeloid leukemia and a deep molecular response without tyrosine kinase inhibitor therapy. Terapevticheskii arkhiv. 2017;89(12):86–96. doi: 10.17116/terarkh2017891286-96. (In Russ)]
  9. Зейфман А.А., Челышева Е.Ю., Туркина А.Г. и др. Роль селективности ингибиторов тирозинкиназ в развитии побочных эффектов при терапии хронического миелолейкоза. Клиническая онкогематология. 2014;7(1):16–27.
    [Zeifman AA, Chelysheva EYu, Turkina AG, et al. Role of tyrosine­kinase inhibitor selectivity in development of adverse effects during treatment of chronic myeloid leukemia. Klinicheskaya onkogematologiya. 2014;7(1):16–27. (In Russ)]
  10. Hochhaus A, Saglio G, Hughes TP, et al. Long-term benefits and risks of frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5-year update of the randomized ENESTnd trial. Leukemia. 2016;30(5):1044–54. doi: 10.1038/leu.2016.5.
  11. Cortes JE, Saglio G, Kantarjian H, et al. Final 5-Year Study Results of DASISION: The Dasatinib Versus Imatinib Study in Treatment-Naive Chronic Myeloid Leukemia Patients Trial. J Clin Oncol. 2016;34(20):2333–40. doi: 10.1200/jco.2015.64.8899.
  12. Ломаиа Е.Г., Романова Е.Г., Сбитякова Е.И. и др. Эффективность и безопасность ингибиторов тирозинкиназ 2-го поколения (дазатиниб, нилотиниб) в терапии хронической фазы хронического миелолейкоза. Онкогематология. 2013;2:22–33.
    [Lomaia EG, Romanova EG, Sbityakova EI, et al. Efficacy and safety of 2nd generation tyrosine kinase inhibitors (dasatinib, nilotinib) in the treatment of chronic phase of chronic myeloid leukemia. Onkogematologiya. 2013;2:22–33. (In Russ)]
  13. Лазорко Н.С., Ломаиа Е.Г., Романова Е.Г. и др. Ингибиторы тирозинкиназ второго поколения и их токсичность у больных в хронической фазе хронического миелолейкоза. Клиническая онкогематология. 2015;8(3):302–8. doi: 10.21320/2500-2139-2015-8-3-302-308.
    [Lazorko NS, Lomaia EG, Romanova EG, et al. Second Generation Tyrosine Kinase Inhibitors and Their Toxicity in Treatment of Patients in Chronic Phase of Chronic Myeloid Leukemia. Clinical oncohematology. 2015;8(3):302–8. doi: 10.21320/2500-2139-2015-8-3-302-308. (In Russ)]
  14. Kantarjian H, Pasquini R, Levy V, et al. Dasatinib or high-dose imatinib for chronic-phase chronic myeloid leukemia resistant to imatinib at a dose of 400 to 600 milligrams daily: two-year follow-up of a randomized phase 2 study (START-R). Cancer. 2009;115(18):4136–47. doi: 10.1002/cncr.24504.
  15. Quintas-Cardama A, Kantarjian H, O’Brien S, et al. Pleural Effusion in Patients With Chronic Myelogenous Leukemia Treated With Dasatinib After Imatinib Failure. J Clin Oncol. 2007;25(25):3908–14. doi: 10.1200/JCO.2007.12.0329.
  16. de Lavallade H, Punnialingam S, Milojkovic D, et al. Pleural effusions in patients with chronic myeloid leukaemia treated with dasatinib may have an immune-mediated pathogenesis. Br J Haematol. 2008;141(5):745–7. doi: 10.1111/j.1365-2141.2008.07108.
  17. Cortes JE, Gambacorti-Passerini C, Deininger MW, et al. Bosutinib versus imatinib for newly diagnosed chronic myeloid leukemia: results from the randomized BFORE trial. J Clin Oncol. 2017;36(3):231–7. doi: 10.1200/jco.2017.74.7162.
  18. Brummendorf HT, Cortes JE, de Souza CA, et al. Bosutinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukaemia: results from the 24-month follow-up of the BELA trial. Br J Haematol. 2015;168(1):69–81. doi: 10.1111/bjh.13108.
  19. Kerkela R, Grazette I, Yacolti R, et al. Cardiotoxicity of the cancer therapeutic agent imatinib mesylate. Nat Med. 2006;12(8):908–16. doi: 10.1038/nm1446.
  20. Hochhaus A, Larson RA, Guilhot F, et al. Long-term outcomes of imatinib treatment for chronic myeloid leukemia. N Engl J Med. 2017;376(10):917–27. doi: 10.1056/nejmoa1609324.
  21. Hadzijusufovic E, Albrecht-Schgoer K, Huber K, et al. Nilotinib-induced vasculopathy: identifi cation of vascular endothelial cells as a primary target site. Leukemia. 2017;31(11):2388–97. doi: 10.1038/leu.2017.245.
  22. Троицкая Е.А., Вельмакин С.В., Кобалава Ж.Д. Концепция сосудистого возраста: новый инструмент оценки сердечно-сосудистого риска. Артериальная гипертензия. 2017;23(2):160–71. doi: 10.18705/1607-419X-2017-23-2-160-171.
    [Troitskaya EA, Velmakin SV, Kobalava ZD. Concept of vascular age: new tool in cardiovascular risk assessment. Arterial’naya gipertenziya. 2017;23(2):160–71. doi: 10.18705/1607-419X-2017-23-2-160-171. (In Russ)]
  23. Туркина А.Г., Лазарева О.В., Челышева Е.Ю. и др. Результаты терапии больных хроническим миелолейкозом по данным российской части международного многоцентрового популяционного исследования Eutos Population-Based Study (EUTOS-PBS). Гематология и трансфузиология. 2019;64(2):106–21. doi: 10.35754/0234-5730-2019-64-2-106-121.
    [Turkina AG, Lazareva OV, Chelysheva EYu, et al. Treatment outcomes in patients with chronic myeloid leukemia according to the Russian part of the EUTOS Population-Based Study. Russian journal of hematology and transfusiology. 2019;64(2):106–21. doi: 10.35754/0234-5730-2019-64-2-106-121. (In Russ)]
  24. Hehlmann R, Lauseker M, Saussele S, et al. Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia. 2017;31(11):2398–406. doi: 10.1038/leu.2017.253.
  25. Rousselot P, Johnson-Ansah H, Huguet F, et al. Personalized daily doses of imatinib by therapeutic drug monitoring increase the rates of molecular responses in patients with chronic myeloid leukemia. Final results of the randomized OPTIM imatinib study. Blood. 2015;126(23):133. doi: 10.1182/blood.v126.23.133.133.
  26. Shah NP, Rousselot P, Schiffer C, et al. Dasatinib in imatinib-resistant or -intolerant chronic-phase, chronic myeloid leukemia patients: 7-year follow-up of study CA180-034. Am J Hematol. 2016;91(9):869–74. doi: 10.1002/ajh.24423.
  27. Marin D, Bazeos A, Mahon FX, et al. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol. 2010;28(14):2381–8. doi: 10.1200/JCO.2009.26.3087.
  28. Ibrahim AR, Milojkovic D, Bua M, et al. Poor adherence is the main reason for loss of CCyR and imatinib failure for CML patients on long term imatinib therapy. Blood. 2010;116(21):3414. doi: 10.1182/blood.v116.21.3414.3414.
  29. Куцев С.И., Шатохин Ю.В. Влияние перерывов терапии иматинибом на достижение цитогенетического и молекулярного ответов у больных хроническим миелолейкозом. Казанский медицинский журнал. 2009;90(6):827–31.
    [Kutsev SI, Shatokhin YuV. Effect of interruptions in imatinib therapy on achievement of cytogenetic and molecular responses in patients with chronic myeloid leukemia. Kazanskii meditsinskii zhurnal. 2009;90(6):827–31. (In Russ)]
  30. Talpaz M, Shah NP, Kantarjian H, et al. Dasatinib in imatinib-resistant Philadelphia chromosome-positive leukemias. N Engl J Med. 2006;354(24):2531–41. doi: 10.1056/NEJMoa055229.
  31. Santana-Hernandez P, Pedraza RCP, Duque SG, et al. Low-Dose Dasatinib as First-Line Treatment for Chronic Myeloid Leukemia: Preliminary Report. Blood. 2017;130(Suppl 1):5254.
  32. Naqvi K, Jabbour E, Skinner J, et al. Long-term follow-up of lower dose dasatinib (50 mg daily) as frontline therapy in newly diagnosed chronic-phase chronic myeloid leukemia. Cancer. 2020;126(1):67–75. doi: 10.1002/cncr.32504.
  33. Carella AM, Lerma E. Durable responses in chronic myeloid leukemia patients maintained with lower doses of imatinib mesylate after achieving molecular remission. Ann Hematol. 2007;86(10):749–52. doi: 10.1007/s00277-007-0326-2.
  34. Cervantes F, Correa JG, Perez I, et al. Imatinib dose reduction in patients with chronic myeloid leukemia in sustained deep molecular response. Ann Hematol. 2017;96(1):81–5. doi: 10.1007/s00277-016-2839-z.
  35. Iriyama N, Ohashi K, Hashino S, et al. The efficacy of reduced-dose dasatinib as a subsequent therapy in patients with chronic myeloid leukemia in the chronic phase: the LD-CML study of the Kanto CML Study Group. Intern Med. 2018;57(1):17–23. doi: 10.2169/internalmedicine.9035-17.
  36. Hjorth-Hansen H, Stenke L, Soderlund S, et al. Dasatinib induces fast and deep responses in newly diagnosed chronic myeloid leukaemia patients in chronic phase: clinical results from a randomised phase-2 study (NordCML006). Eur J Haematol. 2015;94(3):243–50. doi: 10.1111/ejh.12423.
  37. Santos FP, Kantarjian H, Fava C, et al. Clinical impact of dose reductions and interruptions of second-generation tyrosine kinase inhibitors in patients with chronic myeloid leukaemia. Br J Haematol. 2010;150(3):303–12. doi: 10.1111/j.1365-2141.2010.08245.x
  38. Russo D, Martinelli G, Malagola M, et al. Effects and outcome of a policy of intermittent imatinib treatment in elderly patients with chronic myeloid leukemia. Blood. 2013;121(26):5138–44. doi: 10.1182/blood-2013-01-480194.
  39. La Rosee P, Martiat P, Leitner A, et al. Improved tolerability by a modified intermittent treatment schedule of dasatinib for patients with chronic myeloid leukemia resistant or intolerant to imatinib. Ann Hematol. 2013;92(10):1345–50. doi: 10.1007/s00277-013-1769-2.
  40. Faber E, Divoka M, Skoumalova I, et al. A lower dosage of imatinib is sufficient to maintain undetectable disease in patients with chronic myeloid leukemia with long-term low-grade toxicity of the treatment. Leuk Lymphoma. 2016;57(2):370–5. doi: 10.3109/10428194.2015.1056184.
  41. Шухов О.А., Гурьянова М.А., Челышева Е.Ю. и др. Оценка стабильности молекулярного ответа у больных хроническим миелоидным лейкозом на сниженных дозах ингибиторов тирозинкиназ второго поколения. Гематология и трансфузиология. 2020;65(1, приложение 1):111–2.
    [Shukhov OA, Gur’yanova MA, Chelysheva EYu, et al. Assessment of molecular response stability in chronic myeloid leukemia patients treated with second generation tyrosine kinase inhibitors. Gematologiya i transfuziologiya. 2020;65(1, Suppl 1):111–2. (In Russ)]
  42. Clark RE, Polydoros F, Apperley JF, et al. De-escalation of tyrosine kinase inhibitor dose in patients with chronic myeloid leukaemia with stable major molecular response (DESTINY): an interim analysis of a non-randomised, phase 2 trial. Lancet Haematol. 2017;4(7):e310–е316. doi: 10.1016/s2352-3026(17)30066-2.
  43. Clark RE, Polydoros F, Apperley JF, et al. De-escalation of tyrosine kinase inhibitor therapy before complete treatment discontinuation in patients with chronic myeloid leukaemia (DESTINY): a non-randomised, phase 2 trial. Lancet Haematol. 2019;6(7):e375–е383. doi: 10.1016/S2352-3026(19)30094-8.
  44. Rea D, Cayuela J, Dulucq S, et al. Molecular responses after switching from a standard-dose twice-daily nilotinib regimen to a reduced-dose once-daily schedule in patients with chronic myeloid leukemia: a real life observational study (NILO-RED). Blood 2017;130(1): Abstract 590.
  45. Claudiani S, Apperley J, Khan A, et al. Dose reduction of first and second generation TKI is effective in the maintenance of major molecular response and may predict successful TFR in CML patients. Blood. 2018;132(1): Abstract 3007.
  46. Cayssials E, Torregrosa-Diaz J, Gallego-Hernanz P, et al. Low-dose tyrosine kinase inhibitors before treatment discontinuation do not impair treatment-free remission in chronic myeloid leukemia patients: results of a retrospective study. Cancer. 2020;126(15):3438–47. doi: 10.1002/cncr.32940.
  47. Singh N, Kumar L, Meena R, et al. Drug monitoring of imatinib levels in patients undergoing therapy for chronic myeloid leukaemia: comparing plasma levels of responders and non-responders. Eur J Clin Pharmacol. 2009;65(6):545–9. doi: 10.1007/s00228-009-0621-z.
  48. Larson RA, Druker BJ, Guilhot F, et al. Imatinib pharmacokinetics and its correlation with response and safety in chronic-phase chronic myeloid leukemia: a subanalysis of the IRIS study. Blood. 2008;111(8):4022–8. doi: 10.1182/blood-2007-10-116475.
  49. Picard S, Titier K, Etienne G, et al. Trough imatinib plasma levels are associated with both cytogenetic and molecular responses to standard dose imatinib in chronic myeloid leukemia. Blood. 2007;109(8):3496–9. doi: 10.1182/blood-2006-07-036012.
  50. Takahashi N, Wakita H, Miura M, et al. Correlation between imatinib pharmacokinetics and clinical response in Japanese patients with chronic-phase chronic myeloid leukemia. Clin Pharmacol Ther. 2010;88(6):809–13. doi: 10.1038/clpt.2010.186.
  51. Marin D, Bazeos A, Mahon FX, et al. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol. 2010;28(14):2381–8. doi: 10.1200/JCO.2009.26.3087.
  52. Куцев С.И., Оксенюк О.С. Мониторинг в терапии хронического миелолейкоза иматинибом. Клиническая онкогематология. 2009;2(3):225–31.
    [Kutsev SI, Oksenyuk OS. Monitoring in imatinib treatment of chronic myeloid leukemia. Klinicheskaya onkogematologiya. 2009;2(3):225–31. (In Russ)]
  53. Larson RA, Yin OQ, Hochhaus A, et al. Population pharmacokinetic and exposure-response analysis of nilotinib in patients with newly diagnosed Ph+ chronic myeloid leukemia in chronic phase. Eur J Clin Pharmacol. 2012;68(5):723–33. doi: 10.1007/s00228-011-1200-7.
  54. Takahashi N, Miura M, Kuroki J, et al. Multicenter phase II clinical trial of nilotinib for patients with imatinib-resistant or -intolerant chronic myeloid leukemia from the East Japan CML study group evaluation of molecular response and he efficacy and safety of nilotinib. Biomark Res. 2014;2(1):6. doi: 10.1186/2050-7771-2-6.
  55. Tanaka C, Yin OQP, Sethuraman V, et al. Clinical pharmacokinetics of the BCR–ABL tyrosine kinase inhibitor nilotinib. Clin Pharmacol Ther. 2010;87(2):197–203. doi: 10.1038/clpt.2009.208.
  56. Miura M. Therapeutic drug monitoring of imatinib, nilotinib, and dasatinib for patients with chronic myeloid leukemia. Biol Pharm Bull. 2015;38(5):645–54. doi: 10.1248/bpb.b15-00103.
  57. Wang X, Roy A, Hochhaus A, et al. Differential effects of dosing regimen on the safety and efficacy of dasatinib: retrospective exposure–response analysis of a phase III study. Clin Pharmacol. 2013;10(5):85–97. doi: 10.2147/CPAA.S42796.
  58. Mita A, Abumiya M, Miura M, et al. Correlation of plasma concentration and adverse effects of bosutinib: standard dose or dose-escalation regimens of bosutinib treatment for patients with chronic myeloid leukemia. Exp Hematol Oncol. 2018;7(1):9. doi: 10.1186/s40164-018-0101-1.

Dermatological Toxicity of Hydroxycarbamide

IN Subortseva, AL Melikyan, EA Gilyazitdinova, TI Kolosheinova, EI Pustovaya, EK Egorova, AM Kovrigina, AB Sudarikov, AO Abdullaev

National Medical Hematology Research Center, 4a Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Irina Nikolaevna Subortseva, MD, PhD, 4a Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; e-mail: soubortseva@yandex.ru.

For citation: Subortseva IN, Melikyan AL, Gilyazitdinova EA, et al. Dermatological Toxicity of Hydroxycarbamide. Clinical oncohematology. 2018;11(3):252–58.

DOI: 10.21320/2500-2139-2018-11-3-252-258


ABSTRACT

Hydroxycarbamide is an antitumor agent mainly used for treatment of Ph-negative myeloproliferative disorders and sickle cell disease. The development of skin ulcers is a rare but serious adverse event in long-term antitumor therapy. Hydroxycarbamide-induced ulcers are often multiple and bilateral, and usually occur in the lower legs, although they can occur in other regions of the body. The ulcers are small-sized and shallow with sharp margins and yellow fibrine-covered base. They cause constant severe, difficult to treat pain which is a characteristic sign. The drug withdrawal usually leads to spontaneous healing of ulcers. Regular dermatologic screening must be obligatory for all the patients receiving hydroxycarbamide. The present paper provides a literature review on dermatological toxicity of hydroxycarbamide and a clinical case description.

Keywords: hydroxycarbamide, adverse events, dermatologic screening, Ph-negative chronic myeloproliferative disorders.

Received: February 7, 2018

Accepted: May 4, 2018

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REFERENCES

  1. Mathews CK. DNA synthesis as a therapeutic target: the first 65 years. FASEB J. 2012;26(6):2231–7. doi: 10.1096/fj.12-0602ufm.
  2. Yarbro JW, Leavell UW. Hydroxyurea: a new agent for the management of refractory psoriasis. J Ky Med Assoc. 1969;67:899–901.
  3. Lori F, Malykh A, Cara A, et al. Hydroxyurea as an inhibitor of human immunodeficiency virus-type 1 replication. Science. 1994;266(5186):801–5. doi: 10.1126/science.7973634.
  4. Spivak JL, Hasselbalch H. Hydroxycarbamide: a user’s guide for chronic myeloproliferative disorders. Expert Rev Anticancer Ther. 2011;11(3):403–14. doi: 10.1586/era.11.10.
  5. Adunyah SE, Chander R, Barner VK, Cooper RS. Regulation of c-jun mRNA expression by hydroxyurea in human K562 cells during erythroid differentiation. Biochim Biophys Acta. 1995;1263(2):123–32. doi: 10.1016/0167-4781(95)00079-v.
  6. Paleri V, Lindsey L. Oral ulcers caused by hydroxyurea. J Laryngol Otol. 2000;114(12):976–7. doi: 10.1258/0022215001904518.
  7. Lannemyr O, Kutti J. Hydroxyurea as a cause of drug fever in essential thrombocythaemia. Eur J Haematol. 1999;62(5):354–5. doi: 10.1111/j.1600-0609.1999.tb01917.x.
  8. Kalambokis G, Stefanou D, Arkoumani E, et al. Fulminant bronchiolitis obliterans organizing pneumonia following 2 d of treatment with hydroxyurea, interferon-alpha and oral cytarabine ocfosfate for chronic myelogenous leukemia. Eur J Haematol. 2004;73(1):67–70. doi: 10.1111/j.1600-0609.2004.00252.x.
  9. Kennedy BJ, Smith LR, Goltz RW. Skin changes secondary to hydroxyurea therapy. Arch Dermatol. 1975;111(2):183–7. doi: 10.1001/archderm.1975.01630140041002.
  10. Bohn J, Hansen JP, Menne T. Ulcerative lichen planus-like dermatitis due to long-term hydroxyurea therapy. J Eur Acad Dermatol Venereol 1998;10(2):187–9. doi: 10.1111/j.1468-3083.1998.tb00726.x.
  11. Senet P, Aractingi S, Pornkuf M, et al. Hydroxyurea-induced dermatomyositis-like eruption. Br J Dermatol. 1995;133(3):455–9. doi: 10.1111/j.1365-2133.1995.tb02677.x.
  12. Vassallo C, Passamonti F, Merante S, et al. Muco-cutaneous changes during long-term therapy with hydroxyurea in chronic myeloid leukaemia. Clin Exp Dermatol. 2001;26(2):141–8. doi: 10.1046/j.1365-2230.2001.00782.x.
  13. Bahadoran P, Castanet J, Lacour JP, et al. Pseudo-dermatomyositis induced by long-term hydroxyurea therapy: report of two cases. Br J Dermatol. 1996;134(6):1161–2. doi: 10.1111/j.1365-2133.1996.tb07975.x.
  14. Marie I, Joly P, Levesque H, et al. Pseudo-dermatomyositis as a complication of hydroxyurea therapy. Clin Exp Rheumatol. 2000;18(4):536–7.
  15. Quattrone F, Dini V, Barbanera S, et al. Cutaneous ulcers associated with hydroxyurea therapy. J Tissue Viabil. 2013;22(4):112–21. doi: 10.1016/j.jtv.2013.08.002.
  16. Daoud MS, Gibson LE, Pittelkow MR. Hydroxyurea dermopathy: a unique lichenoid eruption complicating long-term therapy with hydroxyurea. J Am Acad Dermatol. 1997;36(2):178–82. doi: 10.1016/s0190-9622(97)70276-7.
  17. Aste N, Fumo G, Contu F, et al. Nail pigmentation caused by hydroxyurea: report of 9 cases. J Am Acad Dermatol. 2002;47(1):146–7. doi: 10.1067/mjd.2002.120910.
  18. Ruzzon E, Randi ML, Tezza F, et al. Leg ulcers in elderly on hydroxyurea: a single center experience in Ph-myeloproliferative disorders and review of literature. Aging Clin Exp Res. 2006;18(3):187–90. doi: 10.1007/bf03324647.
  19. Latagliata R, Spadea A, Cedrone M, et al. Symptomatic mucocutaneous toxicity of hydroxyurea in Philadelphia chromosome-negative myeloproliferative neoplasms: the Mister Hyde face of a safe drug. Cancer. 2012;118(2):404–9. doi: 10.1002/cncr.26194.
  20. Antonioli E, Guglielmelli P, Pieri L, et al. Hydroxyurea related toxicity in 3,411 patients with Ph’-negative MPN. Am J Hematol. 2012;87(5):552–4. doi: 10.1002/ajh.23160.
  21. Salmon-Ehr V, Leborgne G, Vilque JP, et al. Secondary cutaneous effects of hydroxyurea: prospective study of 26 patients from a dermatologic consultation. Rev Med Intern. 2000;21(1):30–4.
  22. Barosi G, Birgegard G, Finazzi G, et al. A unified definition of clinical resistance and intolerance to hydroxycarbamide in polycythaemia vera and primary myelofibrosis: results of a European LeukemiaNet (ELN) consensus process. Br J Haematol. 2010;148(6):961–3. doi: 10.1111/j.1365-2141.2009.08019.x.
  23. Kikuchi K, Arita K, Tateishi Y, et al. Recurrence of hydroxyurea-induced leg ulcer after discontinuation of treatment. Acta Derm Venereol. 2011;91(3):373–4. doi: 10.2340/00015555-1048.
  24. Sanchez-Palacios C, Guitart J. Hydroxyurea-associated squamous dysplasia. J Am Acad Dermatol. 2004;51(2):293–300. doi: 10.1016/j.jaad.2003.11.059.
  25. Young HS, Khan AS, Kendra JR, Coulson IH. The cutaneous side-effects of hydroxyurea. Clin Lab Haematol. 2000;22(4):229–32. doi: 10.1046/j.1365-2257.2000.00311.x.
  26. Dacey MJ, Callen JP. Hydroxyurea-induced dermatomyositis-like eruption. J Am Acad Dermatol. 2003;48(3):439–41. doi: 10.1067/mjd.2003.74.
  27. Velez A, Garcia-Aranda J-M, Moreno J-C. Hydroxyurea-induced leg ulcers: is macroerythrocytosis a pathogenic factor? J Eur Acad Dermatol Venereol. 1999;12(3):243–4. doi: 10.1111/j.1468-3083.1999.tb01037.x.
  28. Engstrom KG, Lofvenberg E. Treatment of myeloproliferative disorders with hydroxyurea: effects on red blood cell geometry and deformability. Blood. 1998;91(10):3986–91.
  29. Bader U, Banyai M, Boni R, et al. Leg ulcers in patients with myeloproliferative disorders: disease or treatment-related? Dermatology. 2000;200(1):45–8. doi: 10.1159/000018315.
  30. Hartmann K, Nagel S, Erichsen T, et al. Cutaneous ulcers following hydroxyurea therapy. Phlebologie. 2004;33(6):202–5.
  31. Kennedy BJ. Hydroxyurea-associated leg ulceration. Ann Intern Med. 1998;129(3):252. doi: 10.7326/0003-4819-129-3-199808010-00017.
  32. Nguyen TV, Margolis DJ. Hydroxyurea and lower leg ulcers. Cutis. 1993;52(4):217–9.
  33. Stahl RL, Silber R. Vasculitic leg ulcers in chronic myelogenous leukemia. Am J Med. 1985;78(5):869–72. doi: 10.1016/0002-9343(85)90297-9.
  34. Burns DA, Sarkany I, Gaylarde P. Effects of hydroxyurea therapy on normal skin: a case report. Clin Exp Dermatol. 1980;5(4):447–9. doi: 10.1111/j.1365-2230.1980.tb01731.x.
  35. Stagno F, Guglielmo P, Consoli U, et al. Successful healing of hydroxyurea-related leg ulcers with topical granulocyte-macrophage colony-stimulating factor. Blood. 1999;94(4):1479–80.
  36. Stone T, Berger A, Blumberg S, et al. A multidisciplinary team approach to hydroxyurea-associated chronic wound with squamous cell carcinoma. Int Wound J. 2012;9(3):324–9.
  37. Natarajan S, Williamson D, Grey J, et al. Healing of an MRSA-colonized, hydroxyurea-induced leg ulcer with honey. J Dermatol Treat. 2001;12(1):33–6. doi: 10.1080/095466301750163563.
  38. Tsuchiya S, Ichioka S, Sekiya N. Hydroxyurea-induced foot ulcer in a case of essential thrombocythaemia. J Wound Care. 2010;19(8):361–4. doi: 10.12968/jowc.2010.19.8.77715.
  39. Fioramonti P, Fino P, Parisi P, et al. A case of hydroxyurea-induced leg ulcer after definitive treatment suspension in a patient affected by thrombocythemia: effectiveness of a new collagenase. In Vivo. 2012;26(6):1053–6.
  40. Martorell-Calatayud A, Requena С, Nagore-Enguidanos E, Guillen-Barona C. Multiple, painful, treatment-resistant leg ulcers associated with dermatomyositis-like lesions over the interphalangeal joints induced by hydroxyurea. Actas Dermo-Sifiliograficas. 2009;100(9):804–7. doi: 10.1016/s1578-2190(09)70176-3.
  41. Varma S, Lanigan SW. Dermatomyositis-like eruption and leg ulceration caused by hydroxyurea in a patient with psoriasis. Clin Exp Dermatol. 1999;24(3):164–6. doi: 10.1046/j.1365-2230.1999.00443.x.
  42. Суборцева И.Н., Гилязитдинова Е.А., Колошейнова Т.И. и др. Предварительные результаты исследования по оценке эффективности и безопасности лечения пациентов с истинной полицитемией и эссенциальной тромбоцитемией цепэгинтерфероном α-2b. Клиническая онкогематология. 2017;10(4):581–2.[Subortseva IN, Gilyazitdinova EA, Kolosheinova TI, et al. Preliminary results of a study evaluating the efficacy and safety of cepeginterferon α-2b therapy of patients with polycythemia vera and essential thrombocythemia. Clinical oncohematology. 2017;10(4):581–2, abstract. (In Russ)]
  43. Меликян А.Л., Туркина А.Г., Абдулкадыров К.М. и др. Клинические рекомендации по диагностике и терапии Ph-негативных миелопролиферативных заболеваний (истинная полицитемия, эссенциальная тромбоцитемия, первичный миелофиброз). Гематология и трансфузиология. 2014;59(4):31–56.[Melikyan AL, Turkina AG, Abdulkadyrov KM, et al. Clinical recommendations for diagnosis and therapy of Ph-negative myeloproliferative disorders (polycythemia vera, essential thrombocythemia, primary myelofibrosis). Gematologiya i transfuziologiya. 2014;59(4):31–56. (In Russ)]
  44. Меликян А.Л., Туркина А.Г., Ковригина А.М. и др. Клинические рекомендации по диагностике и терапии Ph-негативных миелопролиферативных заболеваний (истинная полицитемия, эссенциальная тромбоцитемия, первичный миелофиброз). Гематология и трансфузиология. 2017;62(1):25–60.[Melikyan AL, Turkina AG, Kovrigina AM, et al. Clinical recommendations for diagnosis and therapy of Ph-negative myeloproliferative disorders (polycythemia vera, essential thrombocythemia, primary myelofibrosis). Gematologiya i transfuziologiya. 2017;62(1):25–60. (In Russ)]
  45. Меликян А.Л., Суборцева И.Н. Биология миелопролиферативных новообразований. Клиническая онкогематология. 2016;9(3):314–25. doi: 10.21320/2500-2139-2016-9-314-325.[Melikyan AL, Subortseva IN. Biology of Myeloproliferative Malignancies. Clinical oncohematology. 2016;9(3):314–25. doi: 10.21320/2500-2139-2016-9-314-325. (In Russ)]
  46. Franca ER, Teixeira MA, Matias Kde F, et al. Cutaneous effects after prolongaded use of hydroxyurea in polycythemia vera. Bras Dermatol. 2011;86(4):751–4.
  47. Poros A, Nadasdy K. Leg ulcer in hydroxyurea-treated patients. Haematologia. 2000;30:313–8. doi: 10.1163/156855900300109558.
  48. Yokota K, Tasaka T, Iwata K, et al. Huge postoperative ulcer following hydroxyurea therapy in a patient with polycythemia vera. Haematologica. 2003;88:ECR36.