TY - JOUR
T1 - Renin angiotensin system inhibitors reduce the incidence of arterial thrombotic events in patients with hypertension and chronic myeloid leukemia treated with second- or third-generation tyrosine kinase inhibitors
AU - Mulas, Olga
AU - Caocci, Giovanni
AU - Stagno, Fabio
AU - Bonifacio, Massimiliano
AU - Annunziata, Mario
AU - Luciano, Luigiana
AU - Orlandi, Ester Maria
AU - Abruzzese, Elisabetta
AU - Sgherza, Nicola
AU - Martino, Bruno
AU - Albano, Francesco
AU - Galimberti, Sara
AU - Pregno, Patrizia
AU - Bocchia, Monica
AU - Castagnetti, Fausto
AU - Tiribelli, Mario
AU - Binotto, Gianni
AU - Gozzini, Antonella
AU - Capodanno, Isabella
AU - Fozza, Claudio
AU - Luzi, Debora
AU - Efficace, Fabio
AU - Simula, Maria Pina
AU - Scaffidi, Luigi
AU - De Gregorio, Fiorenza
AU - Elena, Chiara
AU - Trawinska, Malgorzata Monika
AU - Cattaneo, Daniele
AU - Attolico, Imma
AU - Baratè, Claudia
AU - Pirillo, Francesca
AU - Sicuranza, Anna
AU - Gugliotta, Gabriele
AU - Stella, Rossella
AU - Scalzulli, Emilia
AU - Iurlo, Alessandra
AU - Foà, Robin
AU - Breccia, Massimo
AU - La Nasa, Giorgio
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Hypertension is a commonly reported comorbidity in patients diagnosed with chronic myeloid leukemia (CML), and its management represents a challenge in patients treated with 2nd- or 3rd-generation tyrosine kinase inhibitors (TKIs), considering their additional cardiovascular (CV) toxicity. The renin angiotensin system (RAS) contributes to hypertension genesis and plays an important role in atherosclerosis development, proliferation, and differentiation of myeloid hematopoietic cells. We analyzed a cohort of 192 patients with hypertension at CML diagnosis, who were treated with 2nd- or 3rd-generation TKIs, and evaluated the efficacy of RAS inhibitors (angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs)) in the prevention of arterial occlusive events (AOEs), as compared with other drug classes. The 5-year cumulative incidence of AOEs was 32.7 ± 4.2%. Patients with SCORE ≥ 5% (high-very-high) showed a significantly higher incidence of AOEs (33.7 ± 7.6% vs 13.6 ± 4.8%, p = 0.006). The AOE incidence was significantly lower in patients treated with RAS inhibitors (14.8 ± 4.2% vs 44 ± 1%, p < 0.001, HR = 0.283). The difference in the low and intermediate Sokal risk group was confirmed but not in the high-risk group, where a lower RAS expression has been reported. Our data suggest that RAS inhibitors may represent an optimal treatment in patients with hypertension and CML, treated with 2nd or 3rdG TKIs.
AB - Hypertension is a commonly reported comorbidity in patients diagnosed with chronic myeloid leukemia (CML), and its management represents a challenge in patients treated with 2nd- or 3rd-generation tyrosine kinase inhibitors (TKIs), considering their additional cardiovascular (CV) toxicity. The renin angiotensin system (RAS) contributes to hypertension genesis and plays an important role in atherosclerosis development, proliferation, and differentiation of myeloid hematopoietic cells. We analyzed a cohort of 192 patients with hypertension at CML diagnosis, who were treated with 2nd- or 3rd-generation TKIs, and evaluated the efficacy of RAS inhibitors (angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs)) in the prevention of arterial occlusive events (AOEs), as compared with other drug classes. The 5-year cumulative incidence of AOEs was 32.7 ± 4.2%. Patients with SCORE ≥ 5% (high-very-high) showed a significantly higher incidence of AOEs (33.7 ± 7.6% vs 13.6 ± 4.8%, p = 0.006). The AOE incidence was significantly lower in patients treated with RAS inhibitors (14.8 ± 4.2% vs 44 ± 1%, p < 0.001, HR = 0.283). The difference in the low and intermediate Sokal risk group was confirmed but not in the high-risk group, where a lower RAS expression has been reported. Our data suggest that RAS inhibitors may represent an optimal treatment in patients with hypertension and CML, treated with 2nd or 3rdG TKIs.
KW - Arterial occlusive events
KW - Chronic myeloid leukemia
KW - Hypertension
KW - Renin angiotensin system inhibitors
KW - TKI
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U2 - 10.1007/s00277-020-04102-6
DO - 10.1007/s00277-020-04102-6
M3 - Article
AN - SCOPUS:85085622798
JO - Revue d'hématologie
JF - Revue d'hématologie
SN - 0939-5555
ER -