Recurrent arterial occlusive events in patients with chronic myeloid leukemia treated with second- and third-generation tyrosine kinase inhibitors and role of secondary prevention. (1st August 2019)

• Record Type: Journal Article
• Authors: Caocci, Giovanni; Mulas, Olga; Bonifacio, Massimiliano; Abruzzese, Elisabetta; Galimberti, Sara; Orlandi, Ester Maria; Iurlo, Alessandra; Annunziata, Mario; Luciano, Luigiana; Castagnetti, Fausto; Gozzini, Antonella; Stagno, Fabio; Binotto, Gianni; Pregno, Patrizia; Albano, Francesco; Martino, Bruno; Fozza, Claudio; Scaffidi, Luigi; Trawinska, Malgorzata Monika; Baratè, Claudia; Elena, Chiara; Cattaneo, Daniele; Scalzulli, Emilia; La Nasa, Giorgio; Foà, Robin; Breccia, Massimo
• Is Part Of: International journal of cardiology. Volume 288(2019)
• Page Start: 124
• Page End: 127
• Publication Date: 2019-08-01
• Subjects: Chronic myeloid leukemia -- Recurrent arterial occlusive event -- Secondary prophylaxis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.04.051
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Risk of death is particularly high in patients with a previous history of arterial occlusive events (AOEs) and the probability for a recurrent event is around 20%. Little is known about recurrent AOE and the role of secondary prevention in patients with Chronic Myeloid Leukemia (CML) with previous AOE, treated with second- and third-generation tyrosine kinase inhibitors (2 ndG /3 rdG TKIs), nilotinib, dasatinib, bosutinib and ponatinib. Methods: We identified a real-life cohort of 57 consecutive adult CML patients treated with 2 ndG /3 rdG TKI. All patients had a previous history of AOE. Ongoing use of secondary prevention of AOE (including antiplatelet agents, anticoagulant therapy, and statins) before starting a 2 ndG /3 rdG TKI was recorded, as well as CV risk factors. Results: The 60-month cumulative incidence rate of recurrent AOEs was 47.8 ± 10.9%. Despite a history of AOE, 10 patients (16%) were not receiving secondary preventative measures. Patients treated with nilotinib and ponatinib showed a higher incidence of recurrent AOEs (76.7 ± 14.3% and 64 ± 20.1%, respectively) than those treated with dasatinib and bosutinib (44 ± 24.2% and 30.5 ± 15.5%, respectively) ( p = 0.01). Only treatment with a 2 ndG /3 rdG TKI given as second or subsequent line therapy showed a significant association with an increased incidence of recurrent AOE ( p = 0.039). Overall, 17 recurrent AOEs were observed; 3 CV-related deaths were reported. Conclusion: CML patients with a previous history of AOE treated with 2 ndG /3 rdG TKI represent a particular patient population with a higher probability of experiencing a recurrent AOE; individualized treatment is needed to optimize secondary prevention. Highlights: Risk of death is particularly high in patients with a previous history of arterial occlusive events (AOEs) and the probability for a recurrent event is around 20%. Recurrent AOE in patients with Chronic Myeloid Leukemia (CML) treated with second- and third-generation tyrosine kinase inhibitors (2 ndG /3 rdG TKIs), represent a clinical challenge. CML patients with a previous history of AOE treated with 2 ndG /3 rdG TKI represent a particular patient population with a higher probability of experiencing a recurrent AOE; Individualized treatment is needed to optimize secondary prevention.