Table 3.

IDH inhibitors: when to push through and when to stop

Drug name	Dose and frequency	Toxicity	When to push through	When to stop
Ivosidenib32	500 mg orally once per day	DS, QTc prolongation, cytopenias, high WBC	First 6 months, mild to moderate renal and hepatic dysfunction, and mild DS	Hold for severe DS with cardiopulmonary compromise that requires emergent hospitalization with or without renal dysfunction, for QTc prolongation >480 ms (resume when <480 ms). Discontinue for life-threatening cardiac arrythmias, for Guillain-Barré syndrome, or if there is no response (hematologic recovery/blast clearance) after 6 months.
Enasidenib33	100 mg orally once per day	DS, elevated bilirubin, cytopenias, high WBC	First 6 cycles, mild to moderate renal impairment, mild DS, bilirubin <3× ULN	Hold for severe DS with cardiopulmonary compromise requiring emergent hospitalization with or without renal dysfunction, for bilirubin 3× ULN or more and reduce dose to 50 mg once per day. Discontinue if there is no response (hematologic recovery or blast clearance) after 6 months.

DS, differentiation syndrome; ULN, upper limit of normal; WBC, white blood cell count