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Updated: Jul 19, 2026

Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
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New-generation tyrosine kinase inhibitor-associated asymptomatic cerebrovascular stenosis: two illustrative cases

Akihiro Hirayama1, Takatoshi Sorimachi2, Kazuma Yokota2

  • 1Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. a-hira@is.icc.u-tokai.ac.jp.

Acta Neurochirurgica
|November 26, 2021
PubMed

Insights

New-generation tyrosine kinase inhibitors (TKIs) for chronic myelogenous leukemia (CML) can cause asymptomatic cerebral artery stenosis. Early vascular screening may prevent strokes in patients treated with these CML drugs.

Area of Science:

  • Oncology
  • Neurology
  • Pharmacology

Background:

  • New-generation tyrosine kinase inhibitors (TKIs), such as nilotinib and ponatinib, are crucial treatments for chronic myelogenous leukemia (CML).
  • Previous reports have linked these TKIs to symptomatic cerebral ischemia.

Purpose of the Study:

  • To report a previously undocumented association between new-generation TKIs and asymptomatic cerebral artery stenosis.
  • To highlight the potential for cerebrovascular complications in CML patients on these novel therapies.

Main Methods:

  • Case report of two patients in their 40s treated with new-generation TKIs for CML.
  • Evaluation of vascular status using magnetic resonance angiography and carotid ultrasonography.
  • Assessment for pre-existing vascular risk factors.

Main Results:

  • Two patients on new-generation TKIs for CML developed asymptomatic major cerebrovascular stenosis.
  • Neither patient had typical vascular risk factors.
  • Cerebral artery stenosis was identified despite the absence of symptoms.

Conclusions:

  • New-generation TKIs used for CML treatment can induce significant cerebrovascular stenosis asymptomatically.
  • Routine screening of neck and intracranial arteries via imaging may be beneficial for early detection and prevention of TKI-associated cerebral infarctions.
Keywords:
Asymptomatic lesionCerebral infarctionCerebrovascular stenosisTyrosine kinase inhibitor

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