Mutational analysis demonstrated a mutation in KIT exon 11. After excluding other causes of hepatitis, we considered that hepatitis could be attributable to HBVr. A 50-year-old woman with a history of HBV infection over 20 years presented with abdominal pain, hematemesis, hematochezia, and even syncope on December 29, 2018. [27,28], The AASLD-IDSA HCV Guidance provides specific recommendations that address the risk of HBV reactivation following initiation of DAA treatment for HCV as summarized in the following list:[7]. Hepatology 67:1560-1599, 2018 2Terrault NA, Bzowej NH, Chang KM, et al: AASLD guidelines for treatment of chronic hepatitis B. Hepatology 63:261-83, 2016. Imatinib mesylate–uncovering a fast track to adaptive immunity. The patients/participants provided their written informed consent to participate in this study. Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Clin Lymphoma Myeloma Leuk (2019) 19(2):103–8. However, when GIST patients with chronic HBV infection receive imatinib, the risk for HBVr is present. Context: Due to the close relationship between the immune system and the hepatitis B virus (HBV) replication, it is essential to monitor patients with current or past HBV infection under any type of immunosuppression. The 13 page slide set uses simple language and has audio in: Mandarin Chinese, Hmong, Korean, and Vietnamese, as well as English. A literature review was also conducted. J Hepatol 2017; 67:370. Blood (2004) 104(4):1094–9. Results: Five cases were analyzed, including 3 cases in this study. Imatinib mesylate affects the development and function of dendritic cells generated from CD34+ peripheral blood progenitor cells. Nat Rev Clin Oncol (2016) 13(7):431–46. Thus, further research is needed to distinguish the difference in effect of imatinib between viral immunity regulation and tumor immunity regulation. . When the immunity of the body, particularly the cellular immune function, is inhibited, viral replication increases, inducing an imbalance in the mechanisms that lead to HBVr (27). Recommendations for Hepatitis B Viral Infection Testing and Monitoring ... October 2016 - VA HIV, Hepatitis, and Public Health Pathogens Program Background: 1. Hepatitis B virus reactivation associated with a severe hepatitis flare has been increasingly recognized as a potential adverse event associated with HCV DAA therapy. doi: 10.1093/infdis/jix178, 16. Zhonghua Gan Zang Bing Za Zhi (2019) 27(12):938–61. The AASLD-IDSA guidelines do not provide a recommendation regarding stopping or extending therapy in the setting of stable low-level viremia. Hepatitis B and a Healthy Baby – This slide set is audio-visual educational tool that describes the importance of getting babies vaccinated against hepatitis B if a mother has hepatitis B infection. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. The HBV DNA level was 3.10 × 104 IU/mL (normal, <10 IU/mL). The American Association for the Study of Liver Disease (AASLD), the organization that defines how doctors should treat hepatitis B and other liver ailments, unveiled new hepatitis B treatment guidelines this week at its annual conference in San Francisco. In select instances, laboratory monitoring may also be indicated on therapy. This second edition expands the coverage of treatment of various difficult-to-treat patients and will be a welcome guide to the physician in both clinical decision-making and in explaining the benefits and side-effects to the patient. doi: 10.3760/cma.j.issn.1007-3418.2019.12.007, 8. Although several cases of hepatitis B virus reactivation have been described in patients with a history of hepatitis B virus infection while undergoing treatment for hepatitis C virus infection with direct acting antivirals, the question of whether hepatitis B virus surface antigen immune-escape mutations might play a role has not been addressed so far. 550 South Jackson Street 3rd Floor, Ste. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. A 51-year-old man was found to have multiple hepatic masses and a gastric mass after a physical examination in September 2019. Core Tip: Reactivation of hepatitis B virus (HBV) could be fatal in the patients with hepatitis B infection and chemotherapy or immunosuppressive therapy. HBV is a major global health problem chronically affecting more than 257 million people worldwide (7). On October 4, 2016, the US Food and Drug Administration (FDA) released a warning on the risk of reactivation of hepatitis B virus (HBV) in some patients receiving direct-acting antivirals to treat hepatitis C virus (HCV) infections. PD-1 inhibitor disruption due to hepatitis [ Time Frame: 2 months ] Hepatitis B virus (HBV) infection causes chronic hepatitis and has long term complications. 9. WHO. No other hepatotoxic medication, except for imatinib, was taken. On May 15, 2019, the patient was admitted to a local hospital because of increasing systemic edema. Patients on immunosuppressive agents are at risk for reactivation of HBV infection, and guidelines have been developed recommending routine pretreatment screening of patients for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B core antigen (anti-HBc). doi: 10.1007/978-3-319-91439-8_1, 15. Hepatitis B virus reactivation (HBV-R), which can lead to HBV-related morbidity and mortality, is a common and well-known complication that occurs during the treatment of non-Hodgkin lymphoma (NHL) patients with current or past exposure to HBV infection. [1] In addition, to minimize interassay and interlaboratory variation, monitoring should ideally utilize the same HCV RNA assay performed by the same laboratory. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. ... Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Division of Gastroenterology, Hepatology & Nutrition. People with hepatitis C should be tested for hepatitis B before starting antiviral therapies. Leukemia (2004) 18(10):1656–61. [15,34,35,36] The AASLD-IDSA HCV Guidance stratifies the follow-up for persons who achieve an SVR based on the degree of hepatic fibrosis and the risk of HCV reinfection. Hepatitis B virus reactivation in cancer ... conforms to the ethical guidelines of the 1975 Declar- ... (AASLD) 2018 hepatitis B guidance: [6] (1) a≥2 log (100-fold) increase in HBV DNA compared to the baseline level, (2) HBV DNA≥3 log (1000) IU/mL in a patient with previously © 2021 MJH Life Sciences and Contagion Live. In April 2020, her liver function subsequently remained within normal ranges, No HBV DNA was detected, and no evidence of GIST recurrence was found in the abdominal–pelvic CT scan. The liver mass was a metastatic GIST (the maximum tumor diameter was 1.5 cm), which stained positive for DOG1; one lymph node was metastatic (1/1). Recommendations for screening, monitoring, prevention, prophylaxis and therapy of hepatitis B virus reactivation in patients with haematologic malignancies and patients who underwent haematologic stem cell transplantation-a position paper. Seggewiss R, Lore K, Greiner E, Magnusson MK, Price DA, Douek DC, et al. Mantese G. Gastrointestinal stromal tumor: epidemiology, diagnosis, and treatment. More than 80% of GIST patients have benefited from treatment with imatinib (4). The average age of the patients was 61.8 y, with male preponderance (4 of 5 vs. 1 of 5). Serologic tests for HBV showed that the patient was positive for HBsAg, hepatitis B e-antibody (HBeAb), hepatitis B core antigen (HBcAg) but negative for hepatitis B e-antigen (HBeAg) and hepatitis B surface antibody (HBsAb). [16], The optimal and standard approach to monitoring for treatment safety depends on whether ribavirin is a component of the regimen. March 2015. Defective blood dendritic cells in chronic myeloid leukemia correlate with high plasmatic VEGF and are not normalized by imatinib mesylate. The patient was immediately admitted to Xiangya hospital. Recent Results Cancer Res (2018) 212:1–27. However, long-term use of lamivudine may lead to HBV resistance mutations and drug resistance. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms located in the digestive tract, with an estimated annual incidence of 1–2 per 100,000 globally (1, 2). 2018;11(2):124-129. doi:10.14740/gr971w. It is possible that persons with isolated anti-HBc could reactivate HBV during HCV DAA therapy. Elevations in ALT to greater than 5 times the upper limit of normal occurs in up to 1% of all persons taking elbasvir-grazoprevir; therefore, hepatic panel monitoring for persons taking elbasvir-grazoprevir has been recommended by the manufacturer at week 8 and as clinically indicated during therapy (some experts recommend monitoring of ALT every 4 weeks while on elbasvir-grazoprevir). This clinical casebook provides a concise yet comprehensive state-of-the-art review of liver disease. doi: 10.1097/MD.0000000000001014, 6. After admission to the local hospital, he tested positive for HBsAg, HBeAb, and HBcAg but negative for HBsAb, HBeAg, hepatitis C virus, and normal liver function. HBsAg-positive tumor patients are suggested to undergo antiviral therapy 1 week before receiving immunosuppressors or are given antivirals and imatinib simultaneously and continue to suppress the risk for HBVr during treatment. Third, the management and monitoring of HBVr in patients with GIST were not based on research concerning GIST patients with HBVr induced by imatinib but were merely suggested as feasible by current clinical evidence. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Imatinib also inhibits immunity to several disease, such as herpes zoster infection (28), tuberculosis (29), Epstein Barr Virus-positive lymphoproliferative disease (30), and sclerotic-type chronic graft-versus-host disease, in addition to HBVr (31). Front. HL, FT, and ZH were the chief investigator and the senior author of the article. www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Direct-acting_antivirals_indicated_for_treatment_of_hepatitis_C_(interferon-free)/human_referral_prac_000057.jsp&mid=WC0b01ac05805c516f. This study aimed to review the possible mechanism of HBVr induced by imatinib and explore appropriate measures for patient management and monitoring. Meanwhile 1 patient was diagnosed with HBVr during the 10th month of treatment with 6 dose adjustments of imatinib, as follows: 200 mg/d for 10 d, held for 2 weeks; 100 mg/d for 3 months; and 400 mg/d for 40 d, held for 2 weeks, and restarted at 200 mg/d imatinib. Meanwhile, cessation of treatment with imatinib and initiation of antiviral therapy are mandatory following HBVr. Prompt identification of HBV-infected patients is mandatory before administering imatinib to prevent HBVr (36). Monitoring of patients after treatment depends on whether the patient achieved an SVR12 and whether they have advanced fibrosis (Metavir stage 3 or 4). This Volume 2 has 6 chapters and focuses on its diagnosis and management. This book assembles recent achievements in both basic research and clinical management in the field of hepatology, virology and immunology. Articles, Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Italy, Medical Center, University of Rochester, United States, Department of Geriatric Gastroenterology, First Affiliated Hospital, Nanjing Medical University, China. Chinese Society of Hepatology CMA. [12,14,15] Some experts will obtain an HCV RNA level 24 weeks after completing treatment in selected patients, such as those with cirrhosis. Feasibility and Timing of Cytoreduction Surgery in Advanced (Metastatic or Recurrent) Gastrointestinal Stromal Tumors During the Era of Imatinib. BMC Gastroenterol (2014) 14:31. doi: 10.1186/1471-230X-14-31, 18.
[7] Phase 3 trials with DAAs have demonstrated that nearly all patients without cirrhosis had an HCV RNA level at week 4 that was undetectable (or less than the LLOQ); in contrast, a significant proportion of patients with compensated cirrhosis will have a detectable HCV RNA level at week 4. Rationale For Testing to Identify Persons with Chronic HBV Infection Appel S, Boehmler AM, Grunebach F, Muller MR, Rupf A, Weck MM, et al. Blood (2006) 108(10):3406–13. Papers describing the state of the art in cost benefit and cost effectiveness analysis. Published September 16, 2016. Primary tumors were located in the stomach (n=4) or rectum (n=1), and one of our patients with a gastric GIST had liver metastasis. Fox M. Pricey hepatitis C drugs can have deadly side-effect for some: FDA. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. A test for hepatitis B surface antigen (HBsAg) may be used for screening when someone falls into one of the high-risk categories for chronic hepatitis B. 2009 May. She was diagnosed with GIST by gastroscopy and abdominal-pelvic computed tomography (CT) scan. Found inside – Page 453Preventing hepatitis B reactivation due to immunosuppressive drug treatments. JAMA. 2015b;313:1617–8. ... Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. As such, antiviral prophylaxis is not usually indicated in this setting. No change in serum HBV serology was indicated, and the HBV DNA level increased to 3.57 × 106 IU/mL. Reactivation of Hepatitis B Virus Infection. Gastroenterology (2015) 148(1):221–44.e3. Research studies have utilized HCV RNA levels 4 weeks after completing therapy (SVR4), but the SVR4 is not considered as robust a marker for treatment response as an SVR12. Context Despite the 2010 provisional clinical opinion recommendation, there is still evidence of suboptimal hepatitis B virus (HBV) screening among patients at high risk for HBV infection or HBV reactivation … Dig Liver Dis (2019) 51(9):1223–31. This 2019 version covers: (i) the nucleos (t)ide analogs, tenofovir disoproxil fumarate and tenofovir alafenamide; (ii) updates to treatment recommendations and management of drug-resistant hepatitis B virus that reflect the new availability of these drugs; and (iii) new information about hepatitis B virus reactivation with each update. For individuals who test positive for HBsAg, follow-up HBV DNA testing should be performed. Adjuvant treatment with imatinib (400 mg/d) was started on December 23, 2018. Imatinib Mesylate. Sci Adv (2019) 5(2):eaau7130. Black Box Warning: Hepatitis B Reactivation All DAAs now carry a black box warning regarding risk of hepatitis B reactivation while on treatment All patients should be screened for hepatitis B, including sAg and anti-HBc prior to starting Hep C treatment 29 cases of reactivation reported to FDA 2013-2016, 2 have been fatal, 1 liver transplant Terrault NA, Lok ASF, McMahon BJ et al. In addition, an outstanding chapter on the skin involvement during viral hepatitis and the tools to manage them during triple therapy is included in the book. At least annual quantitative HCV RNA testing for reinfection is recommended for persons who inject drugs and for men with HIV who have condomless sex with other men. With the exclusion of other causes of liver injury such as infection with hepatitis A, C, or E virus, cytomegalovirus, Epstein-Barr virus, and autoimmune hepatitis, a diagnosis of imatinib-related chronic HBV reactivation was established. Moreover, c-Abl kinase promotes the CRL4Cdt2 mediated ubiquitination of HBV polymerase and further suppresses HBV replication. 166| Clini Cal liver Disease, vOl 15, nO 4, aPril 2020 An Official Learning Resource of AASLD review Reactivation of Hepatitis B Virus Myint, Tong, and Beaven based on risk to close monitoring with on-demand antivi-ral therapy or antiviral PPX. Casali PG, Abecassis N, Bauer S, Biagini R, Bielack S, Bonvalot S, et al. Hepatitis B Highlights: The Liver Meeting 2014 ... Reactivation of HBV Infection . Third in a series of textbooks on pediatric disease primarily based on annual seminars held at the Gant in Aspen, Colorado as part of the Aspen conference on Pediatric Diseases, directed by the Institute for Pediatric Medical Education ... Clin Infect Dis 2018;67:1477–92; Terrault NA, Lok ASF, McMahon BJ, et al. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infectionq European Association for the Study of the Liver⇑ Summary Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. A follow-up to Emerging Issues and Controversies in Infectious Diseases, this volume provides a comprehensive review of topical issues in infectious diseases, highlighting the controversies related to the newest findings and recommendations ... Abnormal liver function was reported in 3 patients during the 6th month of treatment with imatinib at 400 mg/d and in 1 patient during the 2nd month of the same treatment at the same dose. If treatment of HBV is indicated, it should occur at the same time (or before) starting HCV DAA therapy. Years Immune tolerance Immune clearance HBeAg-positive chronic hepatitis . Some experts evaluate certain patients for SVR24. This review summarizes studies on HBV persistence and reactivation with a focus on the definitions and mechanisms. Individuals with a positive baseline HBsAg should have a baseline HBV DNA level ordered. In the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD-IDSA) Guidance titled Recommendations for Testing, Managing, and Treating Hepatitis C, a rating system is utilized for the level of evidence and the strength of the recommendation. doi: 10.1016/j.dld.2019.07.006, 14. In this example, the HCV RNA assay has an LLOQ of 25 IU/mL and an LOD of 10 IU/mL. The studies involving human participants were reviewed and approved by Xiangya Hospital of Central South University. According to the deputy director of the FDA’s office of Antimicrobial Products, John Farley, MD, MPH, in an interview with NBC News, “Doctors should be screening everybody.”2, However, Farley also noted the importance of tempering concerns about these medications with an awareness of the important benefits. ... (AASLD) COMMENTARY. doi: 10.3748/wjg.v22.i28.6484, 42. doi: 10.1002/hep.21024, 39. 2015;148:220. 9. doi: 10.21147/j.issn.1000-9604.2017.04.01, 11. The 13 page slide set uses simple language and has audio in: Mandarin Chinese, Hmong, Korean, and Vietnamese, as well as English. This text provides a comprehensive, state-of-the art review of this field, and will serve as a valuable resource for students, clinicians, and researchers with an interest in hepatitis B. The book reviews new data about basic and ... The elimination of HCV can result in a potential loss of immunologic control of HBV infection and result in HBV reactivation. World J Gastroenterol (2016) 22(28):6484–500. doi: 10.1038/nm.2438, 33. Guidelines advise hepatitis B screening and use of preventive nucleoside analogue (NA) in patients at risk. Slide credit: clinicaloptions.com . Shintaro Akiyama, Thomas G Cotter, and Atsushi Sakuraba. doi: 10.1016/j.clml.2018.11.008, 43. ... (AASLD/IDSA/IAS-USA. HBVQN : Diagnosis of acute or chronic hepatitis B virus (HBV) infection is based on the presence of HBV serologic markers such as hepatitis B surface antigen (HBsAg) and hepatitis B core IgM antibody (anti-HBc IgM), or the presence of HBV DNA detected by molecular assays. HBVr rarely occurs in patients infected with chronic HBV. In January 2019, the patient manifested abdominal pain. [18] The FDA warning was based on a number of cases reported to the FDA and from published literature. EMA reviews direct-acting antivirals for hepatitis C. EMA website. AASLD. Hepatol Int (2013) 7(2):316–26. On October 4 the US Food and Drug … Anticancer Res (2014) 34(7):3629–34. To promote national and international collaboration to promote clinical care and research in the field of the hepatitis B virus (HBV) To improve awareness among health care professionals and the public regarding the prevention of HBV, screening high risk populations for HBV and management of chronic HBV based on AASLD Guidelines. Curr Opin Gastroenterol (2019) 35(6):555–9. Further inquiries can be directed to the corresponding author. JAMA (2018) 319(17):1802–13. Epub 2014 Oct 31. Hepatitis B reactivation associated with direct acting antiviral therapy for hepatitis C: a review of spontaneous post-marketing cases. Imatinib at 400–800 mg/d inhibits the differentiation and function of dendritic cells (DCs), reducing the efficiency of priming cytotoxic T cell lymphocytes (CTLs) (19, 20). Hepatology. AU Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, Brown RS Jr, Bzowej NH, Wong JB SO Hepatology. These signs and symptoms may include weakness, loss of appetite, nausea, vomiting, light-colored stool, or yellowing of the eyes or skin.1, There have been 24 cases of HBV reactivations reported to the FDA over a 31-month period, although it is likely that more such cases have occurred than have been reported. Slide credit: clinicaloptions.com . All rights reserved. This book provides a comprehensive, state-of-the art review of HBV infection and liver disease. Kusumoto S, Tobinai K. Screening for and management of hepatitis B virus reactivation in patients treated with anti-B-cell therapy. “I think it is important to recognize that these hepatitis C drugs are lifesaving medications.” Farley continued, “What we don’t want to do is discourage patients with hepatitis C from getting treatment.”2, The recommendation to screen patients for HBV infection before use of anti-HCV direct-acting antivirals was released on September 16, 2016, in an update to the American Association for the Study of Liver Diseases/Infectious Diseases Society of America (AASLD/IDSA) guidelines available at HCVguidelines.org.3, Explaining the update, Raymond Chung, MD, co-chair of the HCV Guidance Panel, stated, “Cases of HBV reactivation (an increase of the HBV virus) during or after DAA therapy for HCV have been reported in HBV/HCV co-infected patients who were not already on HBV suppressive therapy.” Chung continued, “The severity of these cases have ranged from mild to severe fulminant liver injury that can be life threatening. Hepatitis B viral reactivation secondary to imatinib treatment in a patient with gastrointestinal stromal tumor. a The risk of HBVr is low in the context of intra-articular steroids or a course of oral steroids for ≤ 7 days. Liver function tests showed elevated aspartate transaminase (AST) at 434.0 U/L (normal, 13.0–35.0 U/L), alanine transaminase (ALT) at 407.0 U/L (normal, 7.0–40.0 U/L), total bilirubin at 24.5 umol/L (normal, 1.7–17.1 umol/L), and direct bilirubin at 12.4 umol/L (normal, 0.0–6.8 umol/L). One patient had artificial extracorporeal liver support and another patient had a liver transplant, and each had a good prognosis. Imatinib mesylate inhibits CD4+ CD25+ regulatory T cell activity and enhances active immunotherapy against BCR-ABL- tumors. [12,31,32] In a review of 44 studies involving more than 4,228 patients who achieved an SVR with an interferon-based regimen, 97% of patients maintained the SVR during the long-term follow-up period. Three commercially available HCV RNA assays are widely used in the United States: Roche COBAS TaqMan Version 1.0, Roche COBAS TaqMan Version 2.0, and the Abbott RealTime HCV (ART) assay. The field of HCV therapeutics continues to evolve rapidly and since the World Health Organization (WHO) issued its first Guidelines for the screening care and treatment of persons with hepatitis C infection in 2014 several new medicines ... 2018;67(4):1560. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. NBC News website. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). However, imatinib can stimulate anticancer responses mediated by T cells, interferon-producing killer DCs and NK cells in patients (11, 32–34). Tang LSY, Covert E, Wilson E, Kottilil S. Chronic Hepatitis B Infection: A Review. The new guidelines are published here . However, a review of the relevant literature suggests that imatinib is directly and/or indirectly (by immunosuppressive function) involved in HBVr (Table 2). This study was supported by the Hunan Provincial Clinical Medical Technology Innovation Guidance Project, China (2018SK52604). A Randomized Phase II Crossover Study of Imatinib or Rituximab for Cutaneous Sclerosis after Hematopoietic Cell Transplantation. European Association for the Study of the Liver. |, Creative Commons Attribution License (CC BY). doi: 10.1177/1078155218790337. People considering direct-acting antiviral (DAA) therapy for hepatitis C should first be tested for hepatitis B virus (HBV) and monitored throughout therapy, as elimination of hepatitis C virus (HCV) can lead to HBV reactivation and worsening of liver disease, according to recent updates to American and European hepatitis C treatment guidelines. Law MF, Ho R, Cheung CK, Tam LH, Ma K, So KC, et al. This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. [14] Available long-term data for durability of treatment response with all-oral DAA therapy suggest SVR12 responses translate into sustained HCV clearance. Two studies show that screening methods for hepatitis B virus (HBV) prior to chemotherapy and treatments for reactivated hepatitis C virus (HCV) during chemotherapy in cancer patients are inadequate. Poster abstract 796. Phases are not always distinct and patients can move from one phase to another and back again without any clinical change. (size, 7 cm × 5 cm × 4 cm mitosis, >5/50 HPF). Blood (2004) 103(2):538–44. View all
Li J, Ye Y, Wang J, Zhang B, Qin S, Shi Y, et al. Imatinib at 400 mg daily was started in accordance with consensus-based medication (10) in 4 patients and 200 mg daily in 1 patient suffering from chronic kidney disease (stage 3b). Waller CF. doi: 10.1182/blood-2003-12-4266, 25. Accessed October 5, 2016. The Check-on-Learning Questions are short and topic related.
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