Dasatinib (Sprycel) is a targeted drug belonging to the class of kinase inhibitors, primarily used for the treatment of Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) and acute lymphoblastic leukemia (ALL).
How to Use Dasatinib (Sprycel)
Correct Administration Method
Dasatinib tablets should be swallowed whole; they must not be chewed, split, or crushed.
The drug can be taken with or without food, once daily, at a fixed time either in the morning or evening.
To reduce the risk of drug interactions, consumption of grapefruit juice should be avoided during the treatment period.
For pediatric patients who have difficulty swallowing whole tablets, the tablets can be dispersed in fruit juice for administration.
Principles for Handling Missed Doses
If a dose is forgotten, it should be taken as soon as possible at the usual dosing time; however, a double dose should not be taken on the same day.
If the time until the next scheduled dose is too short, the missed dose should be skipped, and the next dose should be taken as originally planned.
Dosage Adjustment of Dasatinib (Sprycel)
Adult Baseline Dosage Regimens
The recommended initial dose for adult patients with newly diagnosed chronic-phase CML is 100 mg once daily.
The recommended dose for patients with accelerated-phase CML, myeloid blast-phase CML, lymphoid blast-phase CML, or Ph+ ALL is 140 mg once daily.
Management of Cytopenias
For patients with chronic-phase CML who develop an absolute neutrophil count (ANC) < 0.5 × 10⁹/L or platelets < 50 × 10⁹/L, drug administration should be suspended until ANC ≥ 1.0 × 10⁹/L and platelets ≥ 50 × 10⁹/L. After recovery, the dose should be gradually reduced based on the recurrence of cytopenias.
For patients with advanced-phase CML who develop ANC < 0.5 × 10⁹/L or platelets < 10 × 10⁹/L, a bone marrow examination should be performed to confirm whether the cytopenia is leukemia-related.
Principles for Dose Escalation
Dose escalation may be considered for adult patients who have not achieved hematologic or cytogenetic responses.
For chronic-phase CML, the dose can be escalated to 140 mg once daily; for advanced-phase CML and Ph+ ALL, the dose can be escalated to 180 mg once daily.
Dosage Adjustment for Drug Interactions
When co-administered with strong CYP3A4 inhibitors, the dose of dasatinib needs to be reduced:
Reduce from 140 mg once daily to 40 mg once daily.
Reduce from 100 mg once daily to 20 mg once daily.
Medication for Special Populations of Dasatinib (Sprycel)
Pediatric Patients
The dosage of dasatinib for pediatric patients aged 1 year and older with chronic-phase CML or Ph+ ALL should be determined based on body weight:
10–20 kg: 40 mg once daily.
20–30 kg: 60 mg once daily.
30–45 kg: 70 mg once daily.
≥ 45 kg: 100 mg once daily.
Geriatric Patients
It is recommended to initiate treatment at the lower end of the dosage range. Geriatric patients are more prone to adverse reactions such as fatigue, pleural effusion, and dyspnea, so close monitoring is required.
Pregnant and Lactating Women
Dasatinib may cause fetal harm; the risks and benefits must be carefully weighed when administering the drug to pregnant women.
It is recommended that women of childbearing age and men with partners of childbearing age use effective contraceptive measures during treatment and for 30 days after the last dose.
Lactating women are not advised to breastfeed during treatment and for 2 weeks after discontinuing the drug.
