Table 5. The modified score-based decision approach in the chronic myeloid leukemia patients after the acute toxic imatinib-induced liver injury treated with imatinib less than three months (points).
* This decision approach can be used in patients with less than three month 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; 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.
Factors | Imatinib restart* | Imatinib withdrawal |
The grade of hepatotoxicity reaction | ||
I grade | 1 | 0 |
II grade | 1** | 0 |
III grade | 1/0*** | 1/0 |
IV grade | 0 | 1 |
The presence of the offender concomitant drug probably caused drug interaction | ||
Yes | 1 | 0 |
No | 0 | 1 |
The presence of the viral hepatitis reactivation identified by Polymerase Chain Reaction (PCR+) | ||
Yes | 1 | 0 |
No | 0 | 1 |