The new Systematic Coronary Risk Evaluation (SCORE2 and SCORE2-OP) estimates the risk of arterial occlusive events in chronic myeloid leukemia patients treated with nilotinib or ponatinib
-
Published:2023-11-28
Issue:2
Volume:103
Page:427-436
-
ISSN:0939-5555
-
Container-title:Annals of Hematology
-
language:en
-
Short-container-title:Ann Hematol
Author:
Mulas OlgaORCID, Abruzzese Elisabetta, Luciano Luigiana, Iurlo Alessandra, Attolico Immacolata, Castagnetti Fausto, Galimberti Sara, Bonifacio Massimiliano, Annunziata Mario, Gozzini Antonella, Orlandi Ester Maria, Stagno Fabio, Binotto Gianni, Pregno Patrizia, Fozza Claudio, Loi Maurizio, Trawinska Malgorzata Monika, De Gregorio Fiorenza, Cattaneo Daniele, Albano Francesco, Iezza Miriam, Baratè Claudia, Scaffidi Luigi, Elena Chiara, Giai Valentina, Scalzulli Emilia, Breccia Massimo, La Nasa Giorgio, Caocci GiovanniORCID
Abstract
AbstractPatients with chronic myeloid leukemia (CML) treated with nilotinib or ponatinib may experience arterial occlusive events (AOEs). It is currently recommended to thoroughly assess cardiovascular risk factors before treating CML. We identified 455 consecutive CML adult patients, 335 treated with nilotinib and 120 with ponatinib; 380 patients without previous cardiovascular diseases or diabetes were stratified according to the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Older Persons (SCORE2-OP). This updated algorithm from the European Society of Cardiology (ESC) estimates a 10-year risk of fatal and non-fatal cardiovascular diseases. It is based on sex, age, smoking habits, systolic blood pressure, non-high-density lipoprotein cholesterol, and European geographical region of cardiovascular risk. The SCORE2/SCORE2-OP algorithm translated more patients (50.2%) to the high–very high cardiovascular risk category than the previous SCORE (25.3%). Patients with a high to very high SCORE2/SCORE2-OP risk showed a significantly higher incidence rate of AOEs (69.2% vs. 46.5%, p < 0.001). The older SCORE was less specific in estimating AOEs in patients classified as low-intermediate risk (69.8 vs. 54.2%). In multivariate analysis, no associations were found between AOEs and gender, age, and type or dose of tyrosine kinase inhibitor. Only the SCORE2/SCORE2-OP risk was confirmed as a significant predictive factor (p = 0.028; hazard ratio = 2.2; 95% confidence interval = 1.1–4.5). Patients with AOEs required, in most cases, imaging diagnostic tests, additional drugs, and sometimes invasive procedures, increasing access to visits and hospital management. This real-life study suggested that the SCORE2 and SCORE2-OP charts could help identify cardiovascular fragility in CML patients providing them with more attention and a proper TKI selection.
Funder
Università degli Studi di Cagliari
Publisher
Springer Science and Business Media LLC
Subject
Hematology,General Medicine
Reference31 articles.
1. Bower H, Björkholm M, Dickman PW, Höglund M, Lambert PC, Andersson TML (2016) Life expectancy of patients with chronic myeloid leukemia approaches the life expectancy of the general population. J Clin Oncol 20;34(24):2851–7 2. Malkan UY, Haznedaroglu IC (2023) Chronic myeloid leukemia, tyrosine kinase inhibitors and cardiovascular system. Eur Rev Med Pharmacol Sci 27(12):5493–5506 3. Jain P, Kantarjian H, Boddu PC, Nogueras-González GM, Verstovsek S, Garcia-Manero G et al (2019) Analysis of cardiovascular and arteriothrombotic adverse events in chronic-phase CML patients after frontline TKIs. Blood Adv 3(6):851–861 4. Poch Martell M, Sibai H, Deotare U, Lipton JH (2016) Ponatinib in the therapy of chronic myeloid leukemia. Expert Rev Hematol 9(10):923–932 5. Aghel N, Lipton JH, Atenafu EG, Kim DDH, Delgado DH (2017) Cardiovascular events after exposure to nilotinib in chronic myeloid leukemia: long-term follow-up. Clin Lymphoma Myeloma Leuk 17(12):870-878.e1
|
|