Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Medicine, Icahn School of Medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA.
Leuk Lymphoma. 2020 May;61(5):1147-1157. doi: 10.1080/10428194.2019.1711074. Epub 2020 Jan 27.
Despite remarkable efficacy, there is an emerging concern regarding TKI-associated cardiovascular toxicity in CML. Long term follow-up studies on association between TKI therapy and cardiovascular outcome have been limited. CML patients were accessed from the SEER 18 database from 1992 to 2011. Cardiovascular disease (CVD) specific mortality was calculated comparing the pre-TKI era to the TKI era using the Fine-Gray competing risk model. Overall, the TKI era was associated with a reduced cardiovascular mortality compared with the pre-TKI era (HR = 0.72; 95%CI, 0.59-0.89). Our results argue for continued aggressive screening, identification and management of cardiovascular risk factors among all CML patients, especially the elderly, and further investigation into specific mechanisms, factors and predictors of risks in TKI-treated CML.
尽管 TKI 具有显著的疗效，但人们越来越关注 CML 患者 TKI 相关的心血管毒性。关于 TKI 治疗与心血管结局之间的关系，长期随访研究受到限制。本研究从 1992 年至 2011 年的 SEER 18 数据库中纳入了 CML 患者。使用 Fine-Gray 竞争风险模型比较 TKI 治疗前时代和 TKI 治疗时代，计算心血管疾病（CVD）特异性死亡率。总体而言，与 TKI 治疗前时代相比，TKI 治疗时代的心血管死亡率降低（HR = 0.72；95%CI，0.59-0.89）。我们的研究结果表明，所有 CML 患者，尤其是老年人，需要持续进行积极的心血管风险因素筛查、识别和管理，并且需要进一步研究 TKI 治疗的 CML 中风险的具体机制、因素和预测因素。
