Recurrent arterial occlusive events in patients with chronic myeloid leukemia treated with second- and third-generation tyrosine kinase inhibitors and role of secondary prevention

Giovanni Caocci, Olga Mulas, Massimiliano Bonifacio, Elisabetta Abruzzese, Sara Galimberti, Ester Maria Orlandi, Alessandra Iurlo, Mario Annunziata, Luigiana Luciano, Fausto Castagnetti, Antonella Gozzini, Fabio Stagno, Gianni Binotto, Patrizia Pregno, Francesco Albano, Bruno Martino, Claudio Fozza, Luigi Scaffidi, Malgorzata Monika Trawinska, Claudia BaratèChiara Elena, Daniele Cattaneo, Emilia Scalzulli, Giorgio La Nasa, Robin Foà, Massimo Breccia

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalInternational Journal of Cardiology
DOIs
Publication statusPublished - Jan 1 2019

Keywords

  • Chronic myeloid leukemia
  • Recurrent arterial occlusive event
  • Secondary prophylaxis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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