In this young patient under dasatinib treatment and in MMR after 2 years, I would not consider dose reduction . We dont have scientific support to conclude that by reducing the dose , we will lower infections inmediately .
On the other hand, dose reduction on this patient could lead to a loss of molecular response adding another problem , not ideal at this time.
I would not recommend to reduce dasatinib dose nor TKI change.
ORIGINAL CASE:
One of my CML patients is a 30 year old health worker who was diagnosed 2 years ago in chronic phase, with a low ELTS score. 3 monthly BCR-ABL so far: 68% (diagnosis), 0.6%, 0.07%, 0.045%, 0.028%, 0.018%, 0.024%, 0.021%. Normal FBC otherwise – no cytopenia. No other medical diagnoses.
Give his workplace, he is very concerned about his risk of getting a COVID-19 infection and his risk of getting very sick with it. He has asked me if it would be worthwhile switching from Dasatinib 100mg to Imatinib 400mg in light of some suggestion that dasatinib is more immunosuppressive than imatinib. Alternatively, he asked if he should reduce his dasatinib dose to 70 or 50mg in light of the MDACC study with lower dose.
What would you advise him to do? Would your advice be different if he was 75 years old in the same clinical setting?