A 45- year old man presented with easy fatigue, weight loss and left upper abdominal discomfort and was found to have the following blood results on complete blood count:

a) He was planned for treatment with cytarabine to lower his white blood cell count immediately. Discuss how can tumour lysis syndrome be prevented. List TWO drugs which can be used to prevent or treat tumour lysis syndrome. Discuss their mechanism of action and adverse effects. (9 marks)

b) The patient was subsequently confirmed to have Philadelphia chromosome positive chronic myeloid leukemia in chronic phase. Name THREE specific tyrosine kinase inhibitors which can be used as first line therapy for him. Discuss their general and specific adverse effects. (11 marks)