Cardiovascular Events and Management Strategies Including Tyrosine Kinase Inhibitor Switching, Dose Reduction, and...

The development of tyrosine kinase inhibitors (TKIs) has dramatically improved the treatment outcomes of the chronic myelogenous leukemia-chronic phase (CML-CP). However, cardiovascular events (CVEs), such as hypertension, peripheral arterial occlusive disease, pulmonary arterial hypertension, and cerebral infarction, continue to occur, which highlights the need to develop preventive monitoring and treatment strategies for adverse vascular events. This study retrospectively analyzed the data on CVEs in 63 patients with chronic myeloid leukemia treated with TKIs at a single center between January 1, 2013, and October 31, 2023. TKI treatments were discontinued in one patient and 16 patients owing to clinically significant CVEs and adverse events other than CVEs, respectively. Male patients tended to experience more subclinical cardiovascular abnormalities with increasing age than female patients. No prolongation of the QT interval was observed. During follow-up, improvements in tricuspid regurgitant pressure gradient, brain natriuretic peptide values, and hypertension were observed after reducing the dose of the same TKI, interrupting the TKI treatment, and switching from the newer-generation TKIs to imatinib (IM) or bosutinib (BOS). These findings highlight the importance of blood pressure control and cardiovascular monitoring for CVE prevention in high-risk CML patients. Switching to IM or BOS, TKI dose reduction, or treatment discontinuation was observed to be associated with improvement in cardiovascular parameters in selected patients achieving deep molecular response.