Key Takeaways:

• Jenna Moran, MSN, FNP-BC, outlined strategies for managing tyrosine kinase inhibitor–related toxicities in patients with chronic myeloid leukemia during a session at the National Comprehensive Cancer Network 2026 Annual Congress. 
• The US Food and Drug Administration (FDA) has approved 6 tyrosine kinase inhibitors (TKIs) to treat CML, all of which are associated with hematologic toxicities.
• Assessing baseline clinical risk factors and continually monitoring patient responses can inform treatment decisions and help physicians manage TKI toxicity.

At the NCCN 2026 Annual Congress, Jenna Moran, MSN, FNP-BC, an oncology nurse practitioner at the Mass General Brigham Cancer Institute, outlined the treatment landscape for CML. She provided an overview of current TKIs, their common side effects, and strategies for managing toxicity while supporting positive patient outcomes.

According to Moran, continuously monitoring patient responses can help manage treatment toxicity. She recommends various assessments to determine baseline toxicity, including complete blood count (CBC) with differential, a comprehensive metabolic panel, electrocardiograms (EKGs), and medication reviews. Once patients begin treatment, ongoing monitoring using the Common Terminology Criteria for Adverse Events (CTCAE) grading system can help physicians decide when to hold, reduce, or discontinue TKI therapy.

Approved TKIs and Their Side Effects

Six TKIs have been approved by the US Food and Drug Administration (FDA) to treat CML: imatinib, dasatinib, nilotinib, bosutinib, ponatinib, and asciminib. Hematologic toxicities are common across all 6 drugs, which can occur within 4 to 6 weeks of treatment initiation.

For imatinib, the most common side effects are fluid retention and gastrointestinal (GI) issues, including nausea, vomiting, and diarrhea. To reduce fluid retention, Moran recommended low sodium diets, elevation of the lower extremities, and diuretics for severe swelling. Imatinib can be taken with water to reduce GI discomfort, and premedication with antiemetics or antidiarrheals can be used in severe cases.

Patients receiving dasatinib tend to experience headaches, skin rashes, fluid retention, and GI issues. Pleural effusions can also occur, affecting 30% of patients, presenting as dyspnea, cough, or chest pain. Physicians should evaluate baseline pulmonary status and constantly monitor symptoms.

Hepatotoxicity and skin rashes are most common among patients taking nilotinib, although the drug is also associated with QT prolongation and vascular-occlusive events. Again, monitoring patient risk factors can help reduce adverse events. Educating patients on how to administer treatment can also improve adherence and health outcomes.

The most common side effects for bosutinib are diarrhea, fluid retention, skin rashes, and renal toxicity. Cataloguing patient symptoms and monitoring renal and liver function can help inform physicians of when to hold or reduce treatment.

Ponatinib is associated with hypertension. Serious side effects include arterial and vascular occlusive events, which can occur in up to 31% of patients. In addition to monitoring lab work, Moran recommended providing all patients with baby aspirin and using response-based dosing.

The most common side effects for asciminib include hypertension, fluid retention, skin rashes, and arthralgias. Moran recommended monitoring lipase levels and cardiovascular risk factors to manage toxicity.

Implications for Oncology Care

Since TKIs are long-term medications, reducing treatment toxicity is important for maintaining quality of life among patients with CML.

Monitoring cardiovascular risk factors, pulmonary status, and side effects can help manage TKI toxicity among patients with CML. They may inform physicians of when to hold, reduce, switch, or discontinue treatment.

Reference

Moran J. Managing toxicities of outpatient oral therapies for chronic myeloid leukemia. 2026 NCCN Annual Congress: Hematologic Malignancies. September 18-19, 2026. New York, NY. Accessed September 18, 2026. https://web.cvent.com/hub/events/adf6c070-106a-43d2-a77f-5e2ff9397670/sessions/1298573a-af2f-4160-8188-bd7c97a25cd3?autoPlay=true