Australia and New Zealand consensus statement on the cardiovascular management of patients with chronic lymphocytic leukaemia treated with Bruton's tyrosine kinase inhibitors

IF 1.5 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2025-07-26 DOI:10.1111/imj.70159

Mary Ann Anderson, Farrukh T. Awan, Leanne Berkahn, Kyle Crassini, Hui-Peng Lee, Paula Marlton, Stephen P. Mulligan, Mark Nolan, Constantine Tam, Aaron L. Sverdlov

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Abstract

Background

Bruton's tyrosine kinase inhibitors (BTKi) reduce mortality and morbidity in chronic lymphocytic leukaemia (CLL) but have an association with cardiotoxicities, including hypertension, atrial fibrillation (AF), ventricular arrhythmias (VA) and bleeding. There is currently no specific advice for Australian and New Zealand clinicians.

Aim

In this paper, we aim to provide evidence-based recommendations for risk assessment, monitoring and managing cardiovascular (CV) toxicity to optimise patient outcomes.

Methods

A multidisciplinary roundtable was held on 21 August 2023 to discuss clinical evidence and derive consensus recommendations, which were graded according to class and level of evidence.

Results

Baseline CV risk assessment, including patient history, blood pressure (BP), pulse and ECG, is recommended in all patients before starting a BTKi. Management and monitoring requirements should reflect the patient's risk status. A target BP of 140/90 mmHg should be achieved (or 130/80 mmHg in high-risk patients or those with CV disease). In patients with pre-existing AF, closer monitoring is recommended in consultation with cardiology. Oral anticoagulation is generally warranted in patients with a CHA2DS2-VASc score of ≥2 in males or ≥3 in females. BTKi should be withheld for 3 days before and after a minor procedure and 7 days prior to or post a major procedure. Due to the risk of VA and sudden death, BTKi is generally contraindicated in patients with previous VA, severe or uncontrolled heart failure or hypertension. Multidisciplinary care aims to minimise complications and improve treatment outcomes.

Conclusion

Further research should be directed at validating CV screening tools and measuring outcomes based on these recommendations.

Abstract Image

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澳大利亚和新西兰关于布鲁顿酪氨酸激酶抑制剂治疗慢性淋巴细胞白血病患者心血管管理的共识声明。

背景：布鲁顿酪氨酸激酶抑制剂（BTKi）可降低慢性淋巴细胞白血病（CLL）的死亡率和发病率，但与心脏毒性有关，包括高血压、心房颤动（AF）、室性心律失常（VA）和出血。目前还没有针对澳大利亚和新西兰临床医生的具体建议。目的：在本文中，我们旨在为风险评估、监测和管理心血管（CV）毒性提供循证建议，以优化患者预后。方法：于2023年8月21日召开多学科圆桌会议，讨论临床证据并得出共识建议，并根据证据的类别和水平进行分级。结果：建议所有患者在开始BTKi治疗前进行基线CV风险评估，包括患者病史、血压（BP）、脉搏和心电图。管理和监测要求应反映患者的风险状况。目标血压应达到140/90 mmHg（高危患者或心血管疾病患者目标血压应达到130/80 mmHg）。对于已有房颤的患者，建议在咨询心脏病学的情况下进行更密切的监测。男性CHA2DS2-VASc评分≥2或女性CHA2DS2-VASc评分≥3的患者通常需要口服抗凝治疗。BTKi应在小手术前后3天，在大手术前后7天内保留。由于存在室性心律失常和猝死的风险，既往有室性心律失常、严重或不受控制的心力衰竭或高血压的患者一般禁用BTKi。多学科护理旨在尽量减少并发症和改善治疗结果。结论：进一步的研究应针对验证CV筛选工具和测量这些建议的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.