Background: Risk of death is particularly high in patientswith 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 secondand third-generation tyrosine kinase inhibitors (2ndG/3rdG TKIs), nilotinib, dasatinib, bosutinib and ponatinib. Methods: We identified a real-life cohort of 57 consecutive adult CML patients treated with 2ndG/3rdG 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 2ndG/3rdG TKI was recorded, as well as CV risk factors. Results: The 60-month cumulative incidence rate of recurrent AOEswas 47.8 +/- 10.9\%. Despite a history of AOE, 10 patients (16\%) were not receiving secondary preventativemeasures. Patients treatedwith nilotinib and ponatinib showed a higher incidence of recurrent AOEs (76.7 +/- 14.3\% and 64 +/- 20.1\%, respectively) than those treatedwith dasatinib and bosutinib (44 +/- 24.2\% and 30.5 +/- 15.5\%, respectively) (p= 0.01). Only treatmentwith a 2ndG/3rdG 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 patientswith a previous history of AOE treated with 2ndG/3rdG TKI represent a particular patient population with a higher probability of experiencing a recurrent AOE; individualized treatment is needed to optimize secondary prevention. (c) 2019 Elsevier B. V. All rights reserved.
Recurrent arterial occlusive events in patients with chronic myeloid leukemia treated with second- and third-generation tyrosine kinase inhibitors and role of secondary prevention / Caocci, G., Mulas, O., Bonifacio, M., Abruzzese, E., Galimberti, S., Maria Orlandi, E., Iurlo, A., Annunziata, M., Luciano, L., Castagnetti, F., Gozzini, A., Stagno, F., Binotto, G., Pregno, P., Albano, F., Martino, B., Fozza, C., Scaffidi, L., Monika Trawinska, M., Baratè, C., et al.. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 288:(2019), pp. 124-127. [10.1016/j.ijcard.2019.04.051]
Recurrent arterial occlusive events in patients with chronic myeloid leukemia treated with second- and third-generation tyrosine kinase inhibitors and role of secondary prevention
Francesco Albano;Emilia Scalzulli;Robin Foà;Massimo Breccia
2019
Abstract
Background: Risk of death is particularly high in patientswith 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 secondand third-generation tyrosine kinase inhibitors (2ndG/3rdG TKIs), nilotinib, dasatinib, bosutinib and ponatinib. Methods: We identified a real-life cohort of 57 consecutive adult CML patients treated with 2ndG/3rdG 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 2ndG/3rdG TKI was recorded, as well as CV risk factors. Results: The 60-month cumulative incidence rate of recurrent AOEswas 47.8 +/- 10.9\%. Despite a history of AOE, 10 patients (16\%) were not receiving secondary preventativemeasures. Patients treatedwith nilotinib and ponatinib showed a higher incidence of recurrent AOEs (76.7 +/- 14.3\% and 64 +/- 20.1\%, respectively) than those treatedwith dasatinib and bosutinib (44 +/- 24.2\% and 30.5 +/- 15.5\%, respectively) (p= 0.01). Only treatmentwith a 2ndG/3rdG 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 patientswith a previous history of AOE treated with 2ndG/3rdG TKI represent a particular patient population with a higher probability of experiencing a recurrent AOE; individualized treatment is needed to optimize secondary prevention. (c) 2019 Elsevier B. V. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
