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RESEARCH PRODUCT
Cardiovascular Issues in Tyrosine Kinase Inhibitors Treatments for Chronic Myeloid Leukemia: A Review
Marco SantoroMarco SantoroSalvatrice MancusoSalvatrice MancusoVincenzo AccursoDaniela Di LisiGiuseppina NovoGiuseppina NovoSergio Siragusasubject
0301 basic medicineOncologycardiovascular riskmedicine.medical_specialtychronic myelocytic leukemiacardio-oncologyPhysiologyReviewSettore MED/15 - Malattie Del Sangue03 medical and health sciencescardiovascular events0302 clinical medicineInternal medicinePhysiology (medical)hemic and lymphatic diseasesmedicineNeoplasmQP1-981Medical prescriptionAdverse effectMyeloproliferative neoplasmHematologyMechanism (biology)business.industryMyeloid leukemiamedicine.diseaseSettore MED/11 - Malattie Dell'Apparato Cardiovascolarerespiratory tract diseasestyrosine kinase inhibitions therapy030104 developmental biology030220 oncology & carcinogenesiscardiovascular events chronic myelocytic leukemia cardiovascular risk cardio-oncology tyrosine kinase inhibitions therapybusinessTyrosine kinasedescription
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm driven by a fusion gene, encoding for the chimeric protein BCR-ABL, with constitutive tyrosine kinase activity. The use of tyrosine kinase inhibitors (TKIs) has drastically improved survival, but there are significant concerns about cardiovascular toxicity. Cardiovascular risk can be lowered with appropriate baseline evaluation, accurate choice of TKI therapy, improvement of modifiable cardiovascular risk factors through lifestyle modifications, and prescription of drugs for primary or secondary prevention. Which examinations are necessary, and when do they have to be scheduled? How often should a TKI-treated patient undergo which cardiology test or exam? Is there an accurate way to estimate the risk that each TKI may determine a cardiovascular adverse event in a CML patient? In a few words, how can we optimize the cardiovascular risk management in CML patients before and during TKI treatment? The aim of this review is to describe cardiac and vascular toxicity of TKIs used for CML treatment according to the most recent literature and to identify unmet clinical needs in cardiovascular risk management and complications in these patients. Regarding the TKI-induced cardiovascular toxicity, the full mechanism is still unclear, but it is accepted that different factors may play different roles: endothelial damage and atherosclerosis, metabolic impairment, hypertensive effect, glomerular impairment, and mast-cell disruption. Preventive strategies are aimed at minimizing cardiovascular risk when CML is diagnosed. Cardio-oncology units in specialized hematology centers may afford a personalized and multidisciplinary approach to the patient, optimizing the balance between treatment of the neoplasm and management of cardiovascular risk.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-07-01 | Frontiers in Physiology |