Embedding cardiovascular risk assessment into routine BTK inhibitor management in chronic lymphocytic leukemia

Area of Science:

• Cardio-oncology
• Hematology
• Pharmacology

Background:

• Cardiovascular (CV) toxicities are a significant concern in chronic lymphocytic leukemia (CLL) patients undergoing Bruton tyrosine kinase inhibitor (BTKi) therapy.
• Relying solely on pre-existing CV history may fail to identify patients with latent CV vulnerability, potentially underestimating risks associated with BTKi treatment.

Purpose of the Study:

• To review CV comorbidities and BTKi-associated toxicities in CLL.
• To propose integrating CV risk assessment tools into pre-treatment evaluations for CLL patients receiving BTKi therapy.
• To offer a clinically focused perspective on managing CV risks in this patient population.

Main Methods:

• A targeted, non-systematic literature review of PubMed and MEDLINE.
• Examination of CV comorbidities and BTKi-associated toxicities in CLL.
• Proposal for integrating SCORE2/SCORE2-OP into baseline cardio-oncology assessments.

Main Results:

• Existing CV history may not fully capture latent risks in patients considered for BTKi therapy.
• SCORE2 and SCORE2-OP tools may help identify patients with significant, yet previously unrecognized, CV risk.
• Structured CV risk assessment can guide BTKi selection and management of modifiable risk factors.

Conclusions:

• A structured, risk-adapted framework incorporating objective CV assessment, risk factor modification, and multidisciplinary collaboration can improve BTKi therapy safety in CLL.
• SCORE2 and SCORE2-OP can serve as valuable complementary tools for identifying at-risk patients, pending validation in BTKi-treated CLL populations.
• Proactive CV risk management, including blood pressure optimization and rhythm surveillance, is crucial for patients on BTKi therapy.