TKI Selection Is Critical in Reducing Cardiovascular Risk in Patients With CML

In patients with chronic myeloid leukemia (CML) being treated with tyrosine kinase inhibitors (TKIs), cardiovascular (CV) events are one of the most common complications, according to Carmen Díaz Pedroche, MD, and colleagues. Therefore, Dr. Díaz Pedroche added, choosing the proper TKI and effectively managing risk factors may help lessen the risk for CV comorbidity in this patient population.

“The introduction of TKIs in the treatment of CML marked a significant change in the management and prognosis of this disease,” the study authors wrote. “However, TKI treatment poses new challenges in the management of CML, like those associated with the numerous interactions of these drugs and the adverse effects derived from their use.”

They added that there is no clear agreement about when to refer patients with CML to a cardiologist for assessment and management of CV risk.

60% of Patients Had Some Type of CV Risk Factor

To address this knowledge gap, Dr. Díaz Pedroche and colleagues conducted a study, published in Frontiers in Pharmacology, which examined the CV risk at diagnosis in a cohort of patients with CML (mean age, 50; 45.7% women) and again in a follow-up consultation. They analyzed data from patients who received TKIs and were referred to the specialized consultation between 2015 and 2018. At both diagnosis and at the final consultation, CV risk factors were investigated separately, as well as integrated into the CV SCORE (Systematic Coronary Risk Evaluation) system, which helps determine the risk for death from CV causes within 10 years.

At diagnosis, Dr. Díaz Pedroche and colleagues observed that 60% of patients had some type of risk factor. Furthermore, 20% showed a high- or very high-risk SCORE, 40% were intermediate risk, and 40% were low risk. The main CV adverse event observed at follow-up was hypertension (23%), according to the study team. At the consultation, 17.1% of patients smoked and 28.6% had quit; 11.4% consumed alcohol in the range of abuse, while 34.3% had hypertension, 8.6% had diabetes mellitus, and 40% had dyslipidemia (Table). A thrombotic event was experienced by 5.7% of patients, and a considerable percentage revealed a reduction in their SCORE.

The researchers noted that as a result of CV control in patients with CML receiving treatment with TKI, a reduction of CV risk factors was attained with at least 20% improvement in CV score.

Studies on Multidisciplinary Management of CV Risk in CML Are Lacking

Since CV disease is the second leading cause of mortality among patients with cancer, preventing it is of critical importance, according to Dr. Díaz Pedroche and colleagues. “For this reason, the importance of a multidisciplinary management of patients with malignant hematological disorders [has] increasingly been recognized, although we do not find [it] in […] studies on multidisciplinary management of CV risk in patients with CML, even when various groups have called attention to this need,” they wrote.

When treating patients with CML, adverse effects of TKIs are a significant concern, the study group added. “CV events are among the most frequent and life-threatening complications, and their occurrence can influence the choice or switch of TKI,” the researchers wrote, adding that “follow-up in a specialized consultation is an attainable, feasible approach that can reduce CV risk [in] these patients.”