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Low-density lipoprotein (LDL) levels and risk of arterial occlusive events in chronic myeloid leukemia patients treated with nilotinib

Abstract

Recommendations for dyslipidemia management aimed at reducing arterial occlusive events (AOEs) have been recently published. So far, no data have been reported on the management of dyslipidemia in chronic myeloid leukemia (CML) patients treated with nilotinib. We investigated 369 CML adult patients, stratified according to the new Systematic Coronary Risk Evaluation (SCORE) scoring system. Plasma levels of cholesterol, HDL, LDL, and triglycerides were measured prior to the start of nilotinib and after 3, 6, and 12 months. The 5-year cumulative incidence of AOEs was 15.9%. Patients with cholesterol levels > 200 mg/dL and LDL > 70 mg/dL 3 months after treatment showed a significantly higher incidence of AOEs (21.9 ± 4.6% vs 6.2 ± 2.5, P = 0.003). Patients belonging to the high and very high SCORE risk group showed a significant increase of AOEs (34.4 ± 6% vs 10 ± 2.1%, P < 0.001). In multivariate analysis, both high cholesterol and LDL levels and a high and very high SCORE risk remained significantly associated with the risk of AOEs (P = 0.008; HR = 3.5; 95% CI = 1.4–8.7 and P < 0.001; HR = 4.4; 95% CI = 2–9.8, respectively). Overall, 78 patients (21.1%) presented dyslipidemia at the time of CML diagnosis and 88 (23.3%) after starting nilotinib, but only 26 of them (29.5%) were treated with statins.

Low LDL and cholesterol plasma levels are associated with a significant lower risk of AOEs in CML patients treated with nilotinib in the real life.

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Acknowledgments

We are deeply grateful to the patients who participated in this study and to Emanuela Morelli for English writing assistance.

Funding

This article was carried out within the framework of the research project financed by P.O.R. SARDEGNA F.S.E. 2014–2020 - Asse III “Istruzione e Formazione, Obiettivo Tematico: 10, Obiettivo Specifico: 10.5, Azione dell’accordo fi Partenariato:10.5.12 “Avviso di chiamata per il finanziamento di Progetti di ricerca – Anno 2017”.

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Contributions

GC, OM, and MB conceptualized and designed the study; GC, OM, IC, MB, MA, SG, LL, MT, FC, GB, PP, FS, EA, MB, AG, FA, CF, DL, MPS, LS, CB, FDG, RS, GG, FP, MMT, AS, DC, IA, ES, AI, RF, MB, and GLN collected and assembled the data; GC, OM, and FE performed the statistical analysis; GC wrote the manuscript; GC, OM, IC, MB, MA, SG, LL, MT, FC, GB, PP, FS, EA, MB, AG, FA, CF, DL, FE, MPS, LS, CB, FDG, RS, GG, FP, MMT, AS, DC, IA, ES, AI, RF, MB, and GLN were responsible for the final approval of the manuscript.

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Correspondence to Giovanni Caocci.

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Caocci, G., Mulas, O., Capodanno, I. et al. Low-density lipoprotein (LDL) levels and risk of arterial occlusive events in chronic myeloid leukemia patients treated with nilotinib. Ann Hematol 100, 2005–2014 (2021). https://doi.org/10.1007/s00277-020-04392-w

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  • DOI: https://doi.org/10.1007/s00277-020-04392-w

Keywords

  • Chronic myeloid leukemia
  • Nilotinib
  • Arterial occlusive event
  • LDL
  • Cholesterol
  • Triglycerides