Page 189 - Essential Haematology

Chapter 12 Haematological malignancy: management / 175

Table 12.1 Continued

Mechanism of action Particular side - effects *
Demethylating agents
Azacytidine, decytabine Inhibit DNA methlytransferase Myelosuppression
Signal transduction inhibitors
Imatinib, dasatinib, nilotinib Inhibit tyrosine kinase Myelosuppression, fl uid
retention
Miscellaneous
Corticosteroids Lymphoblast lysis Peptic ulcer, obesity, diabetes,
osteoporosis, psychosis,
hypertension

Trans - retinoic acid Induces differentiation Liver dysfunction, skin
hyperkeratosis, leucocytosis
and hyperviscosity, pleural or
pericardial effusion
Arsenic Induces differentiation or Hyperleucocytosis, cardiac
apoptosis

α - Interferon Activation of RNAase and Flu - like symptoms,
natural killer activity thrombocytopenia, leucopenia,
weight loss
Bortezomid Proteasome inhibition Neuropathy
L - Asparaginase Deprive cells of asparagine Hypersensitivity, low albumin
and coagulation factors,
pancreatitis
Thalidomide Immuno - modulation Neuropathy, constipation,
Lenalidomide thrombosis

Monoclonal antibodies
Rituximab (anti - CD20) Induction of apoptosis Infusion reactions,
immunosuppression
Alemtuzumab (anti - CD52) Lysis of target cell by Infusion reactions,
complement fi xation immunosuppression
Lumiliximab (anti - CD23) Induction of apoptosis Infusion reactions,
immunosuppression
®
Ibritumomab (Zevalin ) Toxicity to bound cell Myelosuppression, nausea
+ 90

(anti - CD20 Y)
Mylotarg (anti - CD33) Kills myeloid cells Myelosuppression
®

* Many of the drugs cause nausea, vomiting, mucositis and bone marrow toxicity, and in large doses infertility. Tissue
necrosis is a problem if the drugs are extravasated during infusion.
†
Allopurinol potentiates the action and side - effects of 6 - mercaptopurine .