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Hematology Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):110-114. doi: 10.1182/asheducation-2017.1.110.

Cardiovascular care of patients with chronic myeloid leukemia (CML) on tyrosine kinase inhibitor (TKI) therapy.

Author information

1
Cardiovascular Division.
2
Cardio-Oncology Program, and.
3
Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN; and.
4
Memorial Sloan-Kettering Cancer Center, New York, NY.

Abstract

Cardiovascular (CV) health has emerged as an important consideration in patients with chronic myeloid leukemia (CML) because of improved prognosis. Indeed, the success of BCR-ABL1 tyrosine kinase inhibitors (TKIs) has increased the focus on survivorship and late toxicity in oncological care. Survivorship issues in this population include CV disease prevention, given its prevalence in the general population. The introduction of BCR-ABL1 TKIs represented a unique concept of indefinite cancer therapy, only recently evolving to include "treatment-free remission." Importantly, later-generation BCR-ABL1 TKIs have been associated with CV complications. Dasatinib has been associated with pleural/pericardial effusions and pulmonary hypertension, whereas nilotinib and ponatinib have been linked to the development of vascular occlusive events. There is currently a dearth of data with respect to the mechanisms of drug toxicities, the subsets of patients at risk, and prevention and treatment strategies to mitigate CV complications in patients with CML. Nevertheless, optimal patient CV risk assessment needs to become a more central tenet of patient care in CML. We propose several practical considerations for the practicing oncologist relative to the CV health of patients with CML, especially those on chronic TKI therapy.

PMID:
29222244
PMCID:
PMC6142546
DOI:
10.1182/asheducation-2017.1.110
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflict-of-interest disclosure: M.C.B. declares no competing financial interests. M.J.M. has received research funding and has consulted for Bristol-Myers Squibb, Novartis Oncology, Pfizer, Takeda, and ARIAD Pharmaceuticals, Inc. J.M. has received research funding and has consulted for Novartis, Pfizer, Bristol-Myers Squibb, Takeda, ARIAD Pharmaceuticals, Inc., Acceleron Pharma, Pharmacyclics, Daiichi Sankyo, and Regeneron Pharmaceuticals.

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