Vascular complications in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors

Abstract

Background: Patients with chronic myeloid leukemia (CML) now have an improved life expectancy similar to that of the general population due to the introduction of tyrosine kinase inhibitors (TKIs). However, many patients experience mild to severe adverse events while undergoing TKI treatment. This review aimed to discuss the adverse events of TKIs, including myocardial infarction and hypertension, and comprehensively analyze strategies for minimizing vascular complications.Current Concepts: Near-fatal cardiovascular events (CVEs) are common among patients receiving nilotinib and ponatinib. However, those receiving other TKIs, such as imatinib and dasatinib, rarely experience CVEs. Among these CVEs, vascular complications, including peripheral arterial occlusion, venous occlusion, and hypertension, are exacerbated in patients with pre-existing vascular risk factors and prolonged TKI use. Therefore, it is crucial to assess predisposing factors to vascular complications and select the optimal TKI to minimize serious CVEs before initiating therapy. Additionally, patients should be closely monitored for vascular complications during nilotinib and ponatinib treatment.Discussion and Conclusion: Despite advancements in therapeutic approaches and research on CML leading to the development of target-specific TKIs aiming to minimize side effects, newer generations are not entirely devoid of adverse events. Hence, it is important for patients and physicians to be knowledgeable about these medications to effectively monitor for side effects, particularly those that are life-threatening, such as vascular toxicity. It is now more important than ever to carefully observe symptoms and perform adequate testing to identify at-risk individuals early and avoid preventable adverse events.