A new paradigm of cardiohematological monitoring in patients with chronic myeloid leukemia taking tyrosine kinase inhibitors

Abstract

Currently, significant progress has been achieved in patients with oncohematological diseases treatment, including chronic myeloid leukemia (CML). This is primarily associated with the development of targeted therapy named tyrosine kinase inhibitors (TKI) – imatinib, nilotinib, bosutinib, dasatinib, ponatinib, etc.). Along with the increased survival of patients with CML, special attention has recently been paid to cardiovascular complications in this group of patients due to the prevalence of cardiovascular diseases in the general population and the toxicity profile of targeted drugs. The article is devoted to the discussion of the cardiovascular risk-reducing strategy in patients with CML. The components of cardiovascular risk in patients with CML are described in detail, and current studies confirm the increased cardiovascular risk in this group of patients compared to the general population, which requires the widespread introduction of cardiovascular prophylaxis for patients with CML. The pathophysiology of the TKI effects on the cardiovascular system are presented, the profiles of cardiovascular toxicity of TKI are considered. The article proposes to implement two concepts in the strategy of cardiovascular prophylaxis in patients with CML – before the start of TKI therapy and during the TKI treatment. The article presents diagnostic measures before the TKI prescribing and for monitoring the TKI therapy, discusses the features of the TKI choice depending on concomitant conditions and diseases. Emphasis is made on the necessity of the risk stratification in patients with CML in accordance with general population algorithms, lifestyle modifications, statin therapy with the achievement of the targeted levels of cardiovascular markers in patients with CML. The article also presents unresolved issues of clinical recommendations and ways to further implement the strategy.