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

Abstract

BACKGROUND\nRisk 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 (2ndG/3rdG TKIs), nilotinib, dasatinib, bosutinib and ponatinib.\n\n\nMETHODS\nWe identified a real-life cohort of 57 consecutive adult CML patients treated with 2ndG/3rdG 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 2ndG/3rdG TKI was recorded, as well as CV risk factors.\n\n\nRESULTS\nThe 60-month cumulative incidence rate of recurrent AOEs was 47.8\u202f±\u202f10.9%. 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\u202f±\u202f14.3% and 64\u202f±\u202f20.1%, respectively) than those treated with dasatinib and bosutinib (44\u202f±\u202f24.2% and 30.5\u202f±\u202f15.5%, respectively) (p\u202f=\u202f0.01). Only treatment with a 2ndG/3rdG TKI given as second or subsequent line therapy showed a significant association with an increased incidence of recurrent AOE (p\u202f=\u202f0.039). Overall, 17 recurrent AOEs were observed; 3 CV-related deaths were reported.\n\n\nCONCLUSION\nCML patients with a previous history of AOE treated with 2ndG/3rdG TKI represent a particular patient population with a higher probability of experiencing a recurrent AOE; individualized treatment is needed to optimize secondary prevention.