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Cardiovascular Adverse Events of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: Clinical Relevance, Impact on Outcome, Preventive Measures and Treatment Strategies

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Opinion Statement

The introduction of TKIs into the therapeutic armamentarium of CML has changed the disease paradigm, increasing long-term survival from 20% to over 80%, with a life expectancy now approaching that of the general population. Although highly effective, TKIs also have a toxicity profile that is often mild to moderate, but sometimes severe, with multiple kinases involved in the development of adverse events (AEs). Among others, cardiovascular AEs observed in TKI-treated CML patients may represent a significant cause of morbidity and mortality, and their pathogenesis is still only partially understood. In view of the recent introduction into daily clinical practice of new TKIs, namely the STAMP inhibitor asciminib, with a distinct safety profile, hematologists now more than ever have the opportunity to select the most suitable TKI for each patient, an aspect that will be fundamental in terms of personalized preventive and therapeutic strategies. Furthermore, physicians should be aware of the feasibility of TKI dose modifications at all stages of the patients’ treatment journey, both at diagnosis for frail or elderly subjects or with multiple comorbidities, and during follow-up for those patients who experience toxicity, as well as to prevent it, with the main objective of reducing side effects while maintaining the response. Consequently, preserving the cardiovascular health of CML patients will likely be a more urgent topic in the near future, with specific measures aimed at controlling cardiovascular risk factors through a multidisciplinary approach involving a panel of healthcare professionals together with the hematologist.

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Authors and Affiliations

  1. Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy

    Alessandra Iurlo MD, PhD, Daniele Cattaneo MD, Cristina Bucelli MD & Francesco Passamonti MD

  2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Daniele Cattaneo MD & Francesco Passamonti MD

  3. Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - Italian IRCCS Cardiology Network, Genova, Italy

    Paolo Spallarossa MD

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  2. Daniele Cattaneo MD
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  3. Cristina Bucelli MD
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  4. Paolo Spallarossa MD
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  5. Francesco Passamonti MD
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All authors wrote the paper and gave their final approval.

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Correspondence to Alessandra Iurlo MD, PhD.

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Iurlo, A., Cattaneo, D., Bucelli, C. et al. Cardiovascular Adverse Events of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: Clinical Relevance, Impact on Outcome, Preventive Measures and Treatment Strategies. Curr. Treat. Options in Oncol. 24, 1720–1738 (2023). https://doi.org/10.1007/s11864-023-01149-1

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