What are the common side effects of tyrosine kinase inhibitors used in the treatment of CML, and how should I manage them?

Common side effects of tyrosine kinase inhibitors (TKIs) used in chronic myeloid leukemia (CML) include gastrointestinal symptoms (nausea, diarrhea, vomiting), fluid retention (peripheral edema), musculoskeletal pain, rash, fatigue, and hepatotoxicity. These adverse effects vary somewhat depending on the specific TKI used but are generally manageable with supportive care and dose adjustments ¹.

Cardiovascular toxicity, including hypertension and arterial occlusive events, is a notable risk particularly with second- and third-generation TKIs, requiring regular monitoring and management of cardiovascular risk factors ¹.

Thyroid dysfunction, especially hypothyroidism, has been increasingly recognized as a side effect of TKIs in CML patients, necessitating periodic thyroid function tests and appropriate endocrine referral or treatment if abnormalities are detected (Sardarova et al., 2025).

Management strategies include symptomatic treatment such as antiemetics for nausea, diuretics for fluid retention, topical or systemic corticosteroids for rash, and analgesics for musculoskeletal pain. Dose interruption or reduction may be required for severe or persistent toxicities ¹.

Regular monitoring of liver function tests is essential due to the risk of hepatotoxicity, and treatment should be adjusted accordingly (Lipton et al., 2024).

Patient education on early recognition of side effects and prompt reporting is critical to optimize adherence and outcomes ¹.