It is an interesting question. I have never seen this type of syndrome in a patient who switched to another TKI, but it could be confused with the initial toxicity features of the next TKI, I guess. I think it is very likely to be a TKI-wide effect, but we are still learning about the withdrawal syndrome. It would be interesting to hear from other clinicians about this issue.
ORIGINAL CASE:
I had a question from a patient who had the musculoskeletal pain syndrome when I stopped imatinib for a trial of TFR. It was quite severe and they really don’t want to go through this again. However unfortunately I had to restart imatinib for a rising Bcr-Abl after which the pain syndrome ceased but replaced by a few chronic side effects from imatinib (cramp, GIT disturbance, oedema) and I have suggested changing to a 2nd generation drug. However they are very worried about getting the imatinib withdrawal syndrome again and wanted to know if it happens if one changes from imatinib to an alternative. I can’t recall any reports of this happening but do you know if there syndrome is only a problem with cessation of a TKI or could it be drug specific and might still occur if changing from imatinib to a 2nd generation TKI?