Enasidenib

• Regular monitoring of blood parameters is advised, once before and then during treatment.‍‍‍‍‍‍​​​‍​​​​​​ If differentiation syndrome is suspected treat with systemic corticosteroids along with continuous monitoring. Differentiation syndrome is a condition associated with rapid proliferation and differentiation of the myeloid cells. The patient may suffer from symptoms of fever, breathing difficulty, weight gain , swelling of legs, liver or kidney damage. The condition can cause multi-organ failure and is potentially fatal. • Treatment with enasidenib tablets must be discontinued if severe respiratory symptoms or kidney dysfunction occur and the patient should be treated appropriately with adequate medical care. • Hydroxyurea can be used to treat noninfectious leukocytosis (increase in white blood cell count in the absence of infection) that occurs during enasidenib therapy and the treatment with enasidenib can be stopped if the leucocytosis does not resolve. • Stop the treatment temporarily and then resume with a low dose of enasidenib (50mg/ day) if tumor lysis syndrome occurs. Tumor lysis syndrome is a side effect of cancer treatment and occurs due to the breakdown of a large number of cancer cells and the release of their contents into the blood. It can cause kidney failure and cardiac rhythm abnormalities. The dose can be increased to 100 mg a day when the toxicity reduces to grade 1 or lower. • Reduce the dose to 50mg per day if the bilirubin levels increase to more than three times the normal in absence of liver disease. • Male and female patients with reproductive potential are advised to use effective contraceptive measures during the enasidenib treatment and to continue the same until 1 month after the last dose. Enasidenib may interfere with the effect of oral contraceptives, therefore additional contraception is advised during treatment.