CML Treatment Decisions Should Factor in Cardiovascular Disease Risk

Cardiovascular disease rates and its associated risks are increased in patients with chronic myelogenous leukemia (CML) treated by community-based oncologists and should impact treatment decisions, according to a recent study.


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Tyrosine kinase inhibitors linked to cardiac events in CML


National Comprehensive Cancer Network (NCCN) current guidelines suggest that certain comorbidities—including cardiovascular disease—be considered when selecting tyrosine kinase inhibitors (TKIs) for the treatment of CML. However, the rate of cardiovascular disease in a real-world analysis of patients with CML has yet to be calculated.

Anna D Coutinho, PhD, Xcenda (Palm Harbor, FL), and colleagues conducted a study to evaluate the prevalence of cardiovascular disease and its risk factors in patients with CML treated by United States community-based oncologists. A total of 1639 adult patients were enrolled with a confirmed diagnosis of CML and at least one encounter after initial diagnosis. Patients were selected from an electronic medical database between 2005 and 2014.

Cardiovascular disease conditions and risk factors were assessed at baseline and during the 5-year follow-up period through use of the International Classification of Diseases, 9th Revision, Clinical Modification diagnoses codes, and information from physician notes. One-year prevalence estimates were standardized by age and gender for comparison to annual rates in the United States population.

Results of the study were published in Clinical Lymphoma, Myeloma & Leukemia (online June 2017; doi:10.1016/j.clml.2017.06.011).

After the 5-years follow-up period, researchers found the prevalence of cardiovascular disease conditions and risk factors for patients with CML were 33.0% and 77.7%, respectively. Standardized prevalence rates at 1 year in patients with CML were significantly increased by factors of 1.3 to 3.5 times for cardiovascular disease conditions, compared with the general United States population.

Additionally, researchers reported that the standardized prevalence rates at 1 year in patients with CML were 20% to 40% higher for hypertension, diabetes, and obesity (P < .001).

Authors of the study concluded that the increased rates of cardiovascular disease observed in their real-world analysis of patients with CML “underscores the importance of current NCCN recommendations to consider cardiovascular risk when selecting TKIs.”—Zachary Bessette