Ross David M, Arthur Chris, Burbury Kate, Ko Brian S, Mills Anthony K, Shortt Jake, Kostner Karam
Department of Haematology, Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, South Australia, Australia.
Royal North Shore Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2018 Feb;48 Suppl 2:5-13. doi: 10.1111/imj.13716.
Several BCR-ABL1 tyrosine kinase inhibitors (TKIs) are approved for the first-line treatment of chronic phase chronic myeloid leukaemia (CML). Disease control is achieved in the vast majority of patients and disease-specific survival is excellent. Consequently, there is now emphasis on managing comorbidities and minimising treatment-related toxicity. Second-generation TKIs have cardiovascular risks that are greater than with imatinib treatment, but these risks must be balanced against the superior CML responses encountered with more potent TKIs. Cardiovascular risk should be assessed at baseline using a locally validated model based on the Framingham risk equation. Clinicians involved in the care of CML patients should be aware of the vascular complications of TKIs and manage cardiovascular risk factors early to mitigate treatment-related risks. Reversible risk factors, such as dyslipidaemia, smoking, diabetes and hypertension, should be addressed. We summarise the available data on cardiovascular complications in CML patients treated with TKIs. Using the latest evidence and collective expert opinion, we provide practical advice for clinicians to assess, stratify and manage cardiovascular risk in people with CML receiving TKI therapy.
几种BCR-ABL1酪氨酸激酶抑制剂（TKIs）已被批准用于慢性期慢性髓性白血病（CML）的一线治疗。绝大多数患者实现了疾病控制，疾病特异性生存率很高。因此，目前重点在于管理合并症并将治疗相关毒性降至最低。第二代TKIs的心血管风险高于伊马替尼治疗，但这些风险必须与更有效的TKIs所带来的更好的CML反应相权衡。应使用基于弗雷明汉风险方程的本地验证模型在基线时评估心血管风险。参与CML患者护理的临床医生应了解TKIs的血管并发症，并尽早管理心血管危险因素以减轻治疗相关风险。应处理可逆的危险因素，如血脂异常、吸烟、糖尿病和高血压。我们总结了接受TKIs治疗的CML患者心血管并发症的现有数据。利用最新证据和专家共识，我们为临床医生提供实用建议，以评估、分层和管理接受TKI治疗的CML患者的心血管风险。
