Can Chronic Myeloid Leukemia (CML) cause back pain?

From the Guidelines

Yes, back pain can occur in patients with chronic myeloid leukemia (CML). Back pain in CML patients may result from several mechanisms, including bone marrow expansion as leukemic cells proliferate and put pressure on surrounding tissues. Some patients experience bone pain, including in the spine, as the disease progresses. Additionally, extramedullary disease (leukemic cells growing outside the bone marrow) can occasionally affect the spine or surrounding tissues. In advanced stages of CML, particularly during blast crisis, bone infiltration by leukemic cells can become more pronounced, potentially causing more severe back pain.

According to the European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia 1, treatment for CML, typically with tyrosine kinase inhibitors (TKIs) like imatinib (Gleevec), nilotinib (Tasigna), or dasatinib (Sprycel), often alleviates these symptoms as the leukemic cell burden decreases. The ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of CML also support the use of TKIs as first-line therapy 1.

It's essential to note that back pain in CML patients can also be caused by other factors, such as osteoporosis or degenerative spine disease, which may require separate evaluation and management. If you have CML and experience back pain, it's crucial to report this symptom to your hematologist/oncologist, as it could indicate disease progression or could be an unrelated issue requiring separate evaluation and management.

Key points to consider:

• Back pain can be a symptom of CML, particularly in advanced stages of the disease
• TKIs are the primary treatment for CML and can help alleviate back pain symptoms
• Back pain in CML patients can also be caused by other factors, requiring separate evaluation and management
• Reporting back pain to a hematologist/oncologist is essential to determine the cause and appropriate treatment.

From the FDA Drug Label

Back pain 17 19 1 1 Back pain 19 17 1 1 Back pain 17 2 15 < 1 Back pain 15 < 1 12 1 Spinal pain

Back pain is reported as an adverse reaction in patients with Chronic Myeloid Leukemia (CML) in the provided drug labels 2 and 3. The frequency of back pain varies across different studies and patient populations, but it is consistently listed as a potential adverse reaction. Therefore, yes, CML can cause back pain.

From the Research

Chronic Myeloid Leukemia and Back Pain

• There is no direct evidence in the provided studies that Chronic Myeloid Leukemia (CML) causes back pain 4, 5, 6, 7, 8.
• However, a study on patient- and physician-reported pain after tyrosine kinase inhibitor discontinuation among patients with CML found that some patients experienced increased musculoskeletal pain, including back pain, after discontinuing TKI therapy 5.
• The study defined increased pain as a physician-reported pain adverse event, a 2-level increase in self-reported musculoskeletal pain, or initiation of a medication for pain 5.
• The results showed that 34.9% of patients had increased pain, including back pain, after TKI discontinuation, but the study did not specify the exact percentage of patients who experienced back pain 5.
• It is essential to note that the provided studies focus on the diagnosis, therapy, and monitoring of CML, and back pain is not a primary symptom or complication of the disease 4, 6, 7, 8.

Tyrosine Kinase Inhibitors and Pain

• Tyrosine kinase inhibitors (TKIs) are a common treatment for CML, and they can cause various side effects, including musculoskeletal pain 4, 5, 6, 7, 8.
• The studies suggest that TKIs can cause pain, but it is not clear if back pain is a specific side effect of TKI therapy 5.
• Patients who experience pain after TKI discontinuation may require alternative treatments or management strategies to alleviate their symptoms 5.

Management of CML and Pain

• The management of CML typically involves TKI therapy, and patients who experience pain or other side effects may need to adjust their treatment plan 4, 6, 7, 8.
• Healthcare providers should monitor patients for signs of pain or other complications and adjust their treatment accordingly 5.
• Further research is needed to understand the relationship between CML, TKI therapy, and back pain, as well as to develop effective management strategies for patients who experience pain or other side effects 5.