Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart

Giovanni Caocci, Olga Mulas, Elisabetta Abruzzese, Luigiana Luciano, Alessandra Iurlo, Immacolata Attolico, Fausto Castagnetti, Sara Galimberti, Nicola Sgherza, Massimiliano Bonifacio, Mario Annunziata, Antonella Gozzini, Ester Maria Orlandi, Fabio Stagno, Gianni Binotto, Patrizia Pregno, Claudio Fozza, Malgorzata Monika Trawinska, Fiorenza De Gregorio, Daniele CattaneoFrancesco Albano, Gabriele Gugliotta, Claudia Baratè, Luigi Scaffidi, Chiara Elena, Francesca Pirillo, Emilia Scalzulli, Giorgio La Nasa, Robin Foà, Massimo Breccia

Research output: Contribution to journalArticle

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Abstract

Arterial occlusive events (AOEs) represent emerging complications in chronic myeloid leukemia (CML) patients treated with ponatinib. We identified 85 consecutive CML adult patients who were treated with ponatinib in 17 Italian centers. Patients were stratified according to the Systematic Coronary Risk Evaluation (SCORE) assessment, based on sex, age, smoking habits, systolic blood pressure, and total cholesterol levels. The 60-month cumulative incidence rate of AOEs excluding hypertension was 25.7%. Hypertension was reported in 14.1% of patients. The median time of exposure to ponatinib was 28 months (range, 3-69 months). Patients with a high to very high SCORE risk showed a significantly higher incidence rate of AOEs (74.3% vs 15.2%, P < 0.001). Patients aged ≥60 years showed a significantly higher incidence rate of AOEs (51.5% vs 16.9%, P = 0.008). In multivariate analysis, no association was found between AOEs and positive history of CV disease, age, dose of ponatinib, previous exposure to nilotinib, and comorbidities. Only the SCORE risk was confirmed as a significant predictive factor (P = 0.01; HR = 10.9; 95% C.I. = 1.7-67.8). Patients aged ≥60 years who were treated with aspirin had a lower incidence rate of AOEs (33.3% vs 61.8%). Among the 14 reported AOEs, 78.6% of them showed grade 3 to 4 toxicity. This real-life study confirmed the increased incidence of AOEs in CML patients treated with ponatinib, with high to very high SCORE risk. We suggest that patients aged ≥60 years who were treated with ponatinib should undergo prophylaxis with 100 mg/day of aspirin. Our findings emphasize personalized prevention strategies based on CV risk factors.

Original languageEnglish
JournalHematological Oncology
DOIs
Publication statusPublished - Jan 1 2019

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Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Incidence
Aspirin
Blood Pressure
Hypertension
ponatinib
Habits
Comorbidity
Multivariate Analysis
Smoking
Cholesterol

Keywords

  • arterial occlusive event
  • chronic myeloid leukemia
  • ponatinib
  • prophylaxis

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart. / Caocci, Giovanni; Mulas, Olga; Abruzzese, Elisabetta; Luciano, Luigiana; Iurlo, Alessandra; Attolico, Immacolata; Castagnetti, Fausto; Galimberti, Sara; Sgherza, Nicola; Bonifacio, Massimiliano; Annunziata, Mario; Gozzini, Antonella; Orlandi, Ester Maria; Stagno, Fabio; Binotto, Gianni; Pregno, Patrizia; Fozza, Claudio; Trawinska, Malgorzata Monika; De Gregorio, Fiorenza; Cattaneo, Daniele; Albano, Francesco; Gugliotta, Gabriele; Baratè, Claudia; Scaffidi, Luigi; Elena, Chiara; Pirillo, Francesca; Scalzulli, Emilia; La Nasa, Giorgio; Foà, Robin; Breccia, Massimo.

In: Hematological Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Caocci, G, Mulas, O, Abruzzese, E, Luciano, L, Iurlo, A, Attolico, I, Castagnetti, F, Galimberti, S, Sgherza, N, Bonifacio, M, Annunziata, M, Gozzini, A, Orlandi, EM, Stagno, F, Binotto, G, Pregno, P, Fozza, C, Trawinska, MM, De Gregorio, F, Cattaneo, D, Albano, F, Gugliotta, G, Baratè, C, Scaffidi, L, Elena, C, Pirillo, F, Scalzulli, E, La Nasa, G, Foà, R & Breccia, M 2019, 'Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart', Hematological Oncology. https://doi.org/10.1002/hon.2606
Caocci, Giovanni ; Mulas, Olga ; Abruzzese, Elisabetta ; Luciano, Luigiana ; Iurlo, Alessandra ; Attolico, Immacolata ; Castagnetti, Fausto ; Galimberti, Sara ; Sgherza, Nicola ; Bonifacio, Massimiliano ; Annunziata, Mario ; Gozzini, Antonella ; Orlandi, Ester Maria ; Stagno, Fabio ; Binotto, Gianni ; Pregno, Patrizia ; Fozza, Claudio ; Trawinska, Malgorzata Monika ; De Gregorio, Fiorenza ; Cattaneo, Daniele ; Albano, Francesco ; Gugliotta, Gabriele ; Baratè, Claudia ; Scaffidi, Luigi ; Elena, Chiara ; Pirillo, Francesca ; Scalzulli, Emilia ; La Nasa, Giorgio ; Foà, Robin ; Breccia, Massimo. / Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart. In: Hematological Oncology. 2019.
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abstract = "Arterial occlusive events (AOEs) represent emerging complications in chronic myeloid leukemia (CML) patients treated with ponatinib. We identified 85 consecutive CML adult patients who were treated with ponatinib in 17 Italian centers. Patients were stratified according to the Systematic Coronary Risk Evaluation (SCORE) assessment, based on sex, age, smoking habits, systolic blood pressure, and total cholesterol levels. The 60-month cumulative incidence rate of AOEs excluding hypertension was 25.7{\%}. Hypertension was reported in 14.1{\%} of patients. The median time of exposure to ponatinib was 28 months (range, 3-69 months). Patients with a high to very high SCORE risk showed a significantly higher incidence rate of AOEs (74.3{\%} vs 15.2{\%}, P < 0.001). Patients aged ≥60 years showed a significantly higher incidence rate of AOEs (51.5{\%} vs 16.9{\%}, P = 0.008). In multivariate analysis, no association was found between AOEs and positive history of CV disease, age, dose of ponatinib, previous exposure to nilotinib, and comorbidities. Only the SCORE risk was confirmed as a significant predictive factor (P = 0.01; HR = 10.9; 95{\%} C.I. = 1.7-67.8). Patients aged ≥60 years who were treated with aspirin had a lower incidence rate of AOEs (33.3{\%} vs 61.8{\%}). Among the 14 reported AOEs, 78.6{\%} of them showed grade 3 to 4 toxicity. This real-life study confirmed the increased incidence of AOEs in CML patients treated with ponatinib, with high to very high SCORE risk. We suggest that patients aged ≥60 years who were treated with ponatinib should undergo prophylaxis with 100 mg/day of aspirin. Our findings emphasize personalized prevention strategies based on CV risk factors.",
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T1 - Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart

AU - Caocci, Giovanni

AU - Mulas, Olga

AU - Abruzzese, Elisabetta

AU - Luciano, Luigiana

AU - Iurlo, Alessandra

AU - Attolico, Immacolata

AU - Castagnetti, Fausto

AU - Galimberti, Sara

AU - Sgherza, Nicola

AU - Bonifacio, Massimiliano

AU - Annunziata, Mario

AU - Gozzini, Antonella

AU - Orlandi, Ester Maria

AU - Stagno, Fabio

AU - Binotto, Gianni

AU - Pregno, Patrizia

AU - Fozza, Claudio

AU - Trawinska, Malgorzata Monika

AU - De Gregorio, Fiorenza

AU - Cattaneo, Daniele

AU - Albano, Francesco

AU - Gugliotta, Gabriele

AU - Baratè, Claudia

AU - Scaffidi, Luigi

AU - Elena, Chiara

AU - Pirillo, Francesca

AU - Scalzulli, Emilia

AU - La Nasa, Giorgio

AU - Foà, Robin

AU - Breccia, Massimo

PY - 2019/1/1

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N2 - Arterial occlusive events (AOEs) represent emerging complications in chronic myeloid leukemia (CML) patients treated with ponatinib. We identified 85 consecutive CML adult patients who were treated with ponatinib in 17 Italian centers. Patients were stratified according to the Systematic Coronary Risk Evaluation (SCORE) assessment, based on sex, age, smoking habits, systolic blood pressure, and total cholesterol levels. The 60-month cumulative incidence rate of AOEs excluding hypertension was 25.7%. Hypertension was reported in 14.1% of patients. The median time of exposure to ponatinib was 28 months (range, 3-69 months). Patients with a high to very high SCORE risk showed a significantly higher incidence rate of AOEs (74.3% vs 15.2%, P < 0.001). Patients aged ≥60 years showed a significantly higher incidence rate of AOEs (51.5% vs 16.9%, P = 0.008). In multivariate analysis, no association was found between AOEs and positive history of CV disease, age, dose of ponatinib, previous exposure to nilotinib, and comorbidities. Only the SCORE risk was confirmed as a significant predictive factor (P = 0.01; HR = 10.9; 95% C.I. = 1.7-67.8). Patients aged ≥60 years who were treated with aspirin had a lower incidence rate of AOEs (33.3% vs 61.8%). Among the 14 reported AOEs, 78.6% of them showed grade 3 to 4 toxicity. This real-life study confirmed the increased incidence of AOEs in CML patients treated with ponatinib, with high to very high SCORE risk. We suggest that patients aged ≥60 years who were treated with ponatinib should undergo prophylaxis with 100 mg/day of aspirin. Our findings emphasize personalized prevention strategies based on CV risk factors.

AB - Arterial occlusive events (AOEs) represent emerging complications in chronic myeloid leukemia (CML) patients treated with ponatinib. We identified 85 consecutive CML adult patients who were treated with ponatinib in 17 Italian centers. Patients were stratified according to the Systematic Coronary Risk Evaluation (SCORE) assessment, based on sex, age, smoking habits, systolic blood pressure, and total cholesterol levels. The 60-month cumulative incidence rate of AOEs excluding hypertension was 25.7%. Hypertension was reported in 14.1% of patients. The median time of exposure to ponatinib was 28 months (range, 3-69 months). Patients with a high to very high SCORE risk showed a significantly higher incidence rate of AOEs (74.3% vs 15.2%, P < 0.001). Patients aged ≥60 years showed a significantly higher incidence rate of AOEs (51.5% vs 16.9%, P = 0.008). In multivariate analysis, no association was found between AOEs and positive history of CV disease, age, dose of ponatinib, previous exposure to nilotinib, and comorbidities. Only the SCORE risk was confirmed as a significant predictive factor (P = 0.01; HR = 10.9; 95% C.I. = 1.7-67.8). Patients aged ≥60 years who were treated with aspirin had a lower incidence rate of AOEs (33.3% vs 61.8%). Among the 14 reported AOEs, 78.6% of them showed grade 3 to 4 toxicity. This real-life study confirmed the increased incidence of AOEs in CML patients treated with ponatinib, with high to very high SCORE risk. We suggest that patients aged ≥60 years who were treated with ponatinib should undergo prophylaxis with 100 mg/day of aspirin. Our findings emphasize personalized prevention strategies based on CV risk factors.

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