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Article: Imatinib-Induced Bone Edema...

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#1 tiredblood


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Posted 14 September 2017 - 07:41 PM

As I sit here surfing the net re: pain with imatinib use, not expecting to find anything but the same old info, I came across this article.  Anyway, thought I'd share it.


Imatinib-Induced Bone Edema: Case Report and Review of Literature



#2 Trey


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Posted 15 September 2017 - 01:17 PM

Interesting.  Never saw anyone describe this bone pain as imatinib TKI induced bone edema, but it makes some sense.  Actually it is not edema of the bone but rather of the hollow space inside the long bones.  The reason for the pain would be too much fluid inside the bones and therefore pressure builds up, creating pain.  This is also why some patients had hip pain prior to diagnosis due to pressure build-up from the rapid expansion of leukemic cells in the marrow inside the pelvis. 


The long bones of the leg as described in the article do not have blood forming red marrow, but rather have yellow marrow (mainly fat cells).  Only babies have this red marrow in all the bones.  Adults lose red marrow in all bones except the pelvis, sternum, the joints of the hip and shoulder, and a couple other spots.  So this article describes yellow marrow edema in the long bones of the legs, so the fat cells in the marrow are holding excess fluid.  Makes me wonder about other fat cells. 


I had this leg bone pain after starting Gleevec, and it was severe for a while, but went away over time.  The docs for the patient in this article stopped Gleevec completely and permanently, which was not the right approach.  He was a GIST tumor patient, so Gleevec is the best TKI for that since the target is c-Kit.  The body sorts this bone pain issue out over time.


Otherwise it was also worth reading if only to see the full body MRI -- interesting but quite odd.


In other news, if you want suggestions about how to cook and eat marrow, read this:


(Since PhilB is reading again.....)

Edited by Trey, 15 September 2017 - 01:18 PM.

#3 kat73


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Posted 15 September 2017 - 03:55 PM

The "fluid in the fat" thing is indeed interesting.  It has seemed to me that the troublesome fat places I have are not only worse, but somehow very wobbly, as if with fluid.  We certainly tend to blame ourselves when it comes to fat - and doctors do, too - and we blame age as well.  But I have been distressed that this is another weird area where my body has seemingly changed "overnight" and very much against my will and I do blame it on interstitial fluid balance problems associated with messing with PDGFR.  I'm truly sorry for people who have pain associated with it.

Dx July 2009 on routine physical.  WBC 94.  Started Gleevec 400 mg Sept 2009.  MMR at 2yrs.  Side effects (malaise, depression/anxiety, fatigue, nausea, periorbital edema) never improved.  Kidney issues developed because of Gleevec.  Switched to Sprycel 70 mg in Aug 2011.  Above side effects disappeared or improved.  Have been MR3.5 - 4.5 ever since.  Two untreated pleural effusions followed by one treated by stopping Sprycel Jan 2017.  After 9 weeks, PCR showed loss of MMR; re-started Sprycel at 50 mg and in 3 months was back to <0.01% IS.  Pleural effusion returned within a couple of months, same as before (moderate, left side only).  Stopped Sprycel 50 mg for 12 weeks; pleural effusion resolved.  At about a monthoff the drug, PCR was 0.03; at 11 weeks it was 2.06 - lost CCyR? Have returned to 50 mg Sprycel for 3 weeks, intending to reduce to 20 mg going forward.

#4 rct


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Posted 21 September 2017 - 07:45 AM

In 2010 we drove out to Portland and saw Druker.  Not long before that, maybe a year, we had a little meet with one of the guys on the Druker team that moved Gleevec from GIST to CML and it worked.  Both that researcher guy and then Druker in his office definitely spoke of this form of edema to my Mrs, who was suffering bad from it.



#5 SunNsand



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Posted 24 September 2017 - 12:09 AM

I saw the article mentioned bone necrosis. I was dx with necrosis in left hip. Is there a way for ohysicians to know if Imatinib caused it?

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