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Is dose reduction possible on imatinib?

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Hello everyone!

I've recently read many posts and stories about people who have successfully reduced their dosage of dasatinib, and if I'm not mistaken there are several people here on this forum who are on 70mg, 50mg and even 20mg and maintaining excellent BCR-Abl results.  My CML is well controlled on 400mg imatinib, but as we all know it's not fun to endure the side effects of the TKIs and longer than is necessary, so I was hoping for some advice before I meet my doctor next week as I'm hoping to discuss dose reduction.

My BCR-Abl levels took quite long to reduce, and I only reached MMR after 24 months on dasatinib.  I developed a rare side effect of swollen lymph nodes and had to discontinue dasatinib, replacing it with imatinib, and my levels have reduced to around MR4 - MR4.5 - my last seven tests were as follows: 

Jul 2020: 0.011%

Nov 2020: 0.018%

Feb 2021: 0.004%

Jun 2021: 0.013%

Oct 2021: 0.003%

Feb 2022: 0.009%

Jun 2022: 0.003%

I know there is quite some variation in these results but I interpret them as being nice and stable for two years now.  My question to the community at large is whether anyone has reduced their dosage of imatinib from 400mg to 300mg or less with any success and whether this is even possible?  My doctor has indicated on several occasions that I'm probably never going to be a candidate for TFR because of my slow response, high risk factor (11% blasts and an enormous spleen when diagnosed) and the fact that I've already changed from dasatinib, but I'd really like to try a dose reduction given that I struggle with side effects.

Thanks in advance and best wishes from a cold and wintery South Africa!

Martin

 

 

Hi Martin, simple answer is yes.

There a long thread on this here

In summary after many years on 400mg imatinib, I reduced to 200mg for year and maintained MMR. I stopped taking the pills and was in TFR for 17 months when BCRABL went above 0.1%. I started again on 400mg, and stayed for a year. I regained MMR in 3 months. After a year (9 months ago) I reduced to 200mg again and am still undetectable. The improvement in side effects was greater in the reduction from 400mg to 200mg than the change from 200mg to 0.

Hope that is useful

Hello Alistair

Thank you so much for the thread and for the detailed information - I'm thrilled to hear that it is possible and read your experience with interest.

Unfortunately, though, it doesn't seem on the cards for me to reduce my dosage just yet.  My doctor is still worried about my high risk CML and also about the fact that my tests bounce in and out of MR4... so she wants to give it a few years yet before considering a dose reduction.  

But thank you so much for sharing this information!

All the best

Martin