Table 3. The personalized decision approach in chronic myeloid leukemia patients after the acute toxic imatinib-induced liver injury after three months of imatinib treatment.

* This decision approach can be used in patients with after three months of imatinib treatment and after the firstly appeared acute imatinib hepatitis or I-II grade of imatinib hepatotoxicity recurrence, if imatinib hepatitis recurs in III-IV grade of hepatotoxicity the imatinib withdrawal should be considered; Patients with the presence of the liver transplantation or imatinib-induced liver cirrhosis caused by autoimmune mechanism only cannot be evaluated by the algorithm. All decisions to restart should be made after the resolving acute hepatitis and after the transaminases normalization as in previously reported cases;

** Imatinib can be restarted in the reduced or the same dose;

*** «Yes» – when hepatoxicity stops less than in one month and does not recurs, «No» - when the hepatoxicity does not stop after one month or recurs;

**** Not applicable if the hepatotoxicity developed earlier than in six months.

EMR, early molecular response

Factors	Imatinib restart*	Imatinib withdrawal
The grade of hepatotoxicity reaction
I grade	Yes	No
II grade	Yes**	No
III grade	Yes/No***	Yes/No
IV grade / the presence of the liver transplantation or imatinib-induced liver cirrhosis caused by drug interaction or viral hepatitis reactivation	No	Yes
The presence of EMR to the imatinib therapy defined as three-month BCR-ABL1IS ≤10%:
Yes	Yes	No
No	No	Yes
The presence of EMR to the imatinib therapy defined as six-month BCR-ABL1IS <1% (if applicable****):
Yes	Yes	No
No	No	Yes
The presence of the offender concomitant drug probably caused drug interaction
Yes	Yes	No
No	No	Yes
The presence of the viral hepatitis reactivation identified by polymerase chain reaction (PCR+)
Yes	Yes	No
No	No	Yes