Nonhematologic toxicity of imatinib mesylate in pediatric patients with chronic myelogenous leukemia: a predominance of musculoskeletal pain;
Heym KM, Gressett Ussery SM, Trinkman H, Philpot LM;
J Pediatr Hematol Oncol. 2015 Mar;37(2):e111-3. doi: 10.1097/MPH.

Therapy with the tyrosine kinase inhibitor imatinib mesylate has become standard  initial treatment for adult and pediatric patients with chronic myelogenous leukemia. Long-term follow-up data are now available in the adult population, and the toxicity profile of imatinib mesylate among adults has been extensively studied and reported. Despite its increasing use in the pediatric population, there are limited data regarding adverse event profiles of imatinib mesylate in children, and few reports exist in the literature focusing on nonhematologic toxicity in this population. This is a review of an institutional experience of nine pediatric patients with imatinib therapy for chronic myelogenous leukemia over an 8-year period of time.  Authors reviewed the occurrence of nonhematologic toxicity in this cohort and the impact of that toxicity on continuation of therapy. It is reported that eight patients experienced nonhematologic toxicity, including nausea/vomiting (44.4%) and musculoskeletal pain (88.9%), three patients (33.3%) required discontinuation of imatinib therapy due to grade 3/4 musculoskeletal pain. They have suggested that this is a rate that is significantly higher than that seen in the adult population. Author emphasized that, as imatinib therapy becomes increasingly widespread in the treatment of pediatric malignancies, there may be different patterns of clinically significant nonhematologic toxicity, including higher grade musculoskeletal pain. This review is important as the clinicians must be aware of musculoskeletal pain with pediatric patients on imatinib meslate therapy,  as a cause of discontinuing of drug therapy.