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.

Immunotherapy Strategies for Gastrointestinal Stromal Tumor

“…The role of immunotherapy in sarcomas is growing fast, with some impressive responses being described [ 26 ]. The preservation of the proper maturation of the leukocytes makes immunotherapy an attractive adjuvant option in GIST treatment since imatinib, except in rare cases, does not lead to leukopenia [ 27 ]. Considering that immunotherapy can have a role in GIST, several pre-clinical and clinical trials have been conducted (summarized in Table 1 ).…”