title: Imatinib-induced agranulocytosis in patients with gastrointestinal stromal tumors.
abstract: Agranulocytosis is a rare but serious side effect of imatinib in gastrointestinal stromal tumor (GIST) patients. Imatinib is an inhibitor of the proto-oncogene tyrosine kinase (c-kit) and the first-line agent in patients with locally advanced and metastatic GIST. Little evidence is available on the management of this adverse event, and consensus-based guidelines are lacking. In this article, we describe 4 patients with agranulocytosis after starting imatinib. In addition, an overview of the available literature concerning the underlying mechanisms is given, and therapeutic strategies for overcoming this adverse event are discussed. In our experience it appears safe to restart imatinib after normalization of neutrophil count. In case of relapse of agranulocytosis, reintroduction combined with prednisolone, with treatment with granulocyte colony-stimulating factor or dose reduction can be considered.
authors: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam, the Netherlands.
authors: Sheima
authors: S
authors: Farag
authors: Leiden University Medical Center, Department of Clinical Oncology, Leiden, the Netherlands.
authors: Arjan J
authors: AJ
authors: Verschoor
authors: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam, the Netherlands.
authors: Jacob W
authors: JW
authors: Bosma
authors: Leiden University Medical Center, Department of Clinical Oncology, Leiden, the Netherlands.
authors: Hans
authors: H
authors: Gelderblom
authors: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam, the Netherlands.
authors: J Martijn
authors: JM
authors: Kerst
authors: Erasmus MC - Cancer Institute, Department of Medical Oncology, Rotterdam, the Netherlands.
authors: Stefan
authors: S
authors: Sleijfer
authors: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam, the Netherlands.
authors: Neeltje
authors: N
authors: Steeghs
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000276:immunology; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D000068877:Imatinib Mesylate / Q000009:adverse effects*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy; D000090063:Proto-Oncogene Mas
chemical_list: D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; C000715470:MAS1 protein, human; D000090063:Proto-Oncogene Mas; D016179:Granulocyte Colony-Stimulating Factor; D000068877:Imatinib Mesylate
keywords: GIST; Gleevec; Glivec; agranulocytosis; gastrointestinal stromal tumor; imatinib mesylate; neutropenia