Identifying Patients at Risk for TKI-Related Treatment Intolerance

Selecting the appropriate treatment for CML requires a detailed understanding of each therapy’s adverse event profile. Commonly used therapies vary in their adverse effect burden, ranging from mild but frequent issues such as diarrhea, muscle cramps, and edema to less common but more serious toxicities such as vascular events or pleural effusions. Although some drugs are well tolerated, others may present dosing inconveniences or gastrointestinal disturbances. Understanding both patient expectations and daily quality-of-life concerns helps clinicians prepare patients for the experience of long-term therapy.

Personalized treatment selection is essential, particularly for patients with comorbidities. Risk factors such as smoking history, cardiovascular disease, or pulmonary conditions can significantly influence drug tolerability. For instance, patients with prior lung disease may be more prone to pleural effusion with certain treatments. Similarly, preexisting hypertension or diabetes may raise concerns about vascular adverse effects. The goal is to match each patient with a therapy that minimizes serious risks while maintaining efficacy. First-generation treatments may offer a safer side effect profile, though second-generation options often provide deeper responses and faster disease control.

A thorough clinical evaluation—including cardiovascular risk assessment, history of prior toxicities, and lifestyle factors such as body mass index or smoking status—can help identify patients at greater risk for intolerance. Equally important is maintaining ongoing dialogue between the health care team and the patient. Treatment for CML can span years, even a lifetime, so achieving a balance between disease control and quality of life is paramount. Monitoring labs, adjusting doses when necessary, and ensuring patients feel heard and supported throughout treatment can improve adherence and long-term outcomes. As the therapeutic landscape evolves, continuous learning and communication remain the cornerstone of personalized care.