Vol. 5, Issue 1, Part A (2023)

Imatinib mesylate is a tyrosine kinase inhibitor (TKI) that targets BCR-ABL, c-kit, and PDGF receptors. It is a first line treatment in chronic myeloid leukemia in Senegal, while second line treatments are expensive in our practice. Adverse skin effects are generally well tolerated and the most common are edema, maculopapular rash or diverse eruptions (lichenoid eruptions, Steven-Johnson syndrome, hyperpigmentation and hypopigmentation). 
Objectives: Our aim was to identify the cutaneous side effects in phototype VI Senegalese patients who received Imatinib mesylate for the treatment of chronic myeloid leukemia. 
Methodology: We performed a descriptive study in population with dark complexion. The study was conducted in the Hematology unit of National Center of transfusion, in Dakar, Senegal. We included the patients who received imatinib mesylate (IM) for chronic myeloid leukemia from January 2008 to December 2017. We excluded those treated for another affection by IM. Socio-demographic, clinical, biological and therapeutic data were recorded by a structured questionnaire. We analysed data by software CS Pro 7.0 and to Stata 12.0 by EPi-info version. The Pearson Chi square test and the Fischer bilateral exact test were used to compare frequencies. If p<0.05, the difference was considered statistically significant. 
Results: We collected data from 60 patients treated with imatinib mesylate during approximatively 39 months. Among them 55% (n=33) developed cutaneous side effects. The sex ratio was 0.94 (16 males/ 17 females) and the median age of entire cohort was 46,7 years. Fifty-two patients received a daily dosage of 400 mg, and 8 received a 600mg daily dosage. The median time to onset of cutaneous disease was 3, 73 months. 
The following adverse cutaneous effects were found: generalized hypopigmentation (n=21), localized hypopigmentation (n=2), periorbital edema (n=4), Stevens-Johnson syndrome (n=3), eczematous dermatitis (n=3), cutaneous dermatophytosis (n=2), hyperpigmentation (n=2), alopecia(n=2), fixed pigmented eruption (n=1), onychodystrophy (n=1), folliculitis(n=1), stomatitis(n=1) and lichenoid reaction(n=1). Extra-dermatological toxicity was observed in 23 patients (38.33%). Skin side effects were mostly associated with gastrointestinal (n=16) and hematologic (n=14) side effects. We found no difference between age, sex and the apparition of cutaneous side effects but it was an association between the dose of the imatinib mesylate (p=0,027) and the stage of the disease ((p=0,047).

Conclusion: cutaneous side effects of Imatinib mesylate are common among patients among the patients followed for chronic myeloid leukemia. Hypopigmentation was the most frequent; we found an association between cutaneous side effects and the dose of Imatinib mesylate.