I agree with John that this degree of menorrhagia is quite unusual and while it could be exacerbated by the imatinib it should be investigated fully, rather than assuming that this is just an imatinib toxicity. Actually I am concerned that this patient has not achieved CCR after more than 12 months of imatinib. It may be a good time to review this patients adherence and look for possible drug interactions. If drug adhernece is satisfactory, it may be worth considering higher doses of imatinib, however this may not be possible based on this patient's toxicity to standard dose. They should also be closely monitored if possible to ensure that they do achieve CCR (or ideally MMR) over the next 6 months.

Regards

Tim

I have never seen nor heard of such severe menorrhagia associated imatinib. It could of course be associated with a CML-related platelet dysfunction, but it might really be independent of the CML and its treatment. Largely I have no contribution to make.

John Goldman

I just got a complaint of mennorhagia in a 27-year old woman who has been on imatinib for chronic phase CML since August last year. The patient achieved CHR within 3 months of therapy but she is yet to achieve CCR.

The menstrual irregularity with heavy blood loss started just 3 months ago. Bleeding was so heavy she changes her pad 2hrly. She now has a moderate anaemia of 30% PCV, but WBC and platelets were esentially normal. LMP was 28 of this month, coming some 27day after the previous LMP of 1 Dec. The December episode suggested some remission compared 12-15 days intervals before. She is already on iron supplement.

How common is this complication? Does it require hormonal intervention?

Muheez