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Switching from Imatinib to Dasatinib (11Yo patient)

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My 11yo was diagnosed with CML in April 23. He has been on Imatinib 300mg since. His response to treatment was very good in the first 6 months as his qPCR fell to 4% or so but 9 month reading was at 1.2% and 12 month at 1.8%. Per his doctor's reco, we are shifting him to Dasatinib 70mg. We did a mutation analysis that turned out negative

He had severe muscle pain with Imatinib which was addressed with D3 supplements. He also had very low tolerance to cold and would always cover himself with blanket even in temperatures that felt hot to others. But there were mostly manageable side effects

What Dasatinib related side effects should we expect in a child? I read headaches and diarrhoea are the most common ones. Any tips and how to manage those? Of course i have read about more serious ones like pleural effusion etc

I have been following the forum and it has been very useful> any help/advice etc would be most welcome

Thank you!

I think 70 mg for 11 yo is too much. After Imatinib stopped working for me, I went on 50 mg Dasatinib for 4 months and then on 100 mg for 8 months, had the same bcr response, but increased because my platelets went up to 900 while on 50 mg.

It seems those who respond to dasstinib, respond to smaller doses as well while they significantly reduce the risks.

I would contact Bristol Myers Squibb for advice on dosage for kids. I don’t like the suggested dose.

Consider Asciminib if possible, it seems to have the best safety profile, while being more effective than previous TKIs. I‘ve been taking it for a month, after 6 months on Nilotinib, and I feel much better.

For cold extremities try sea kelp supplements with natural iodine and check thyroid markers.

A lack of response without mutations seems to be related to chronic inflamation. Ask the doctor to check IL-1b, IL-6, IL-17, TNF-a. I have the same problem and I‘ve been researching it, so will post here once I get a better understanding and do the tests.

Thanks! Will discuss with out onco

3oK@ - the doses for paediatric cases are based on weight.

70mg would indicate a child between 30-45kg.

- 10-20kg = 40mg
- 20-30kg = 60mg
- 30-45kg = 70mg
- 45kg+ = 100mg

There's no point in contacting BMS, because these are their numbers so that's what they'll tell you.

But I would consider this just the appropriate starting dose. With a good response, for a decent amount of time then anything is possible and lowering the dose over time is very much something that should be discussed with the doctor.

David.

Okay, you may be right, but it doesn’t make much sense.

From 20kg to 45kg, the dose doubles.
From 45kg to 100kg, it’s the same dose.

I would at least seek a 2nd opinion.

pleural effusion, dasatinib is notorious for pleural effusion.
might take a few years, might not.

I suppose volume of blood might not be linear with weight. And there’s much more to it than that.

Paediatric CML is really complex, much less studied than adult CML. Some kids don’t grow all that well on TKIs, so it’s really just not as simple as we’d hope. Really we need a TKI that allows kids to grow normally, or near normally. You’d take a slow acting one of them over a faster growth restricting one.

David.

Hi, I changed from Imatinib to Dasatinib because side effects were awful for me .I feel so much better on Dasatinib but no way would I take more than 50 mg as an adult to start with so suggesting 70 mg for a child is way too high ,please don’t let that happen .Headaches ,pleural effusions,he will suffer .

How long does it take for pleural effusion to show up, if at all?

My doctor said there are no rules, it’s very individual.