Cardiovascular toxicities of BCR-ABL tyrosine kinase inhibitors in chronic myeloid leukemia: preventive strategies and cardiovascular surveillance

Abstract

Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment and outcomes of chronic myeloid leukemia (CML). Despite their significant impact on the management of CML, there is growing evidence that TKIs may cause cardiovascular and/or metabolic complications. In this review, we present the current evidence regarding the cardiovascular safety profiles of BCR-ABL TKIs. Methodological challenges of studies that reported the cardiovascular safety of TKIs are discussed. We also propose management strategies for cardiovascular surveillance and risk factor modification during treatment with these agents.

Keywords: BCR-ABL; adverse event; cardiovascular disease; peripheral arterial disease; tyrosine kinase inhibitor.

Figure 1

Proposed cardiovascular assessment and surveillance in patients receiving TKIs for CML. Abbreviations: TKIs, tyrosine kinase inhibitors; CML, chronic myeloid leukemia; CAD, coronary artery disease; PAD, peripheral arterial disease; CHF, congestive heart failure; PHTN, pulmonary hypertension; CVE, cardiovascular event; PAH, pulmonary artery hypertension; CV, cardiovascular; CVD, cardiovascular disease; Hem, hematology; ABI, ankle–brachial index; CPD, cardiopulmonary disease; ACC/AHA, American College of Cardiology/American Heart Association; LDL, low-density lipoprotein; hsCRP, high-sensitivity C-reactive protein.