Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Houston, Texas, USA.
Cancer. 2023 Jul 15;129(14):2192-2200. doi: 10.1002/cncr.34787. Epub 2023 Apr 5.
Continuous ibrutinib administration is needed to maintain efficacy in patients with chronic lymphocytic leukemia (CLL) and, as such, long-term toxicity is a concern. The authors report the 5-year follow-up of patients with CLL who received treatment with ibrutinib with a focus on hypertension and cardiovascular toxicities.
Patient characteristics were assessed, including blood pressure, cardiovascular disease, disease progression, and death. Univariate logistic regression analysis assessed the relation of patient characteristics and the development of new or worsened hypertension. The incidence of hypertensive outcomes was evaluated using competing risk. Survival was estimated using the Kaplan-Meier method.
Three hundred patients with CLL who were treated with ibrutinib on clinical trials were included. The median patient age at study enrollment was 65 years (range, 29-83 years). Seventy percent of patients were men, and 88% were Caucasian. Sixty-nine percent of patients had hypertension at baseline, and 47% were on antihypertensive medication. Eighty-eight percent had relapsed or refractory CLL. New-onset and worsening hypertension were common, occurring in 68.5% and 38% of patients, respectively. Systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg was observed in 16.9% of patients. Hypertension was reversible after ibrutinib discontinuation. Older age, male sex, tobacco use, and chronic kidney disease were associated with ibrutinib-related hypertension. Baseline hypertension was not associated with major adverse cardiovascular events in ibrutinib-treated patients nor with event-free or overall survival.
Hypertension is a common toxicity in patients with CLL who receive ibrutinib but is manageable in most patients. Other than chronic kidney disease, baseline cardiovascular disease did not affect ibrutinib-related hypertension nor was hypertension associated with major adverse cardiovascular events or survival.
Ibrutinib is an effective treatment for patients with chronic lymphocytic leukemia. Ibrutinib is a well tolerated therapy, however hypertension can develop or worsen in patients receiving ibrutinib and other cardiovascular events are significant challenges to the use of this drug. This may be particularly true in patients with heart disease. Short-term side effects may worsen heart disease, but the long-term impact is unknown. The long-term results of ibrutinib on heart disease and hypertension are described.
为了维持慢性淋巴细胞白血病（CLL）患者的疗效，需要持续给予伊布替尼治疗，因此长期毒性是一个关注点。作者报告了接受伊布替尼治疗的 CLL 患者的 5 年随访结果，重点关注高血压和心血管毒性。
评估患者特征，包括血压、心血管疾病、疾病进展和死亡。单变量逻辑回归分析评估了患者特征与新发或恶化高血压的关系。使用竞争风险评估高血压结局的发生率。使用 Kaplan-Meier 方法估计生存情况。
300 名接受临床试验伊布替尼治疗的 CLL 患者纳入研究。研究入组时患者的中位年龄为 65 岁（范围 29-83 岁）。70%的患者为男性，88%为白种人。69%的患者基线时有高血压，47%正在服用降压药物。88%的患者患有复发或难治性 CLL。新发和恶化的高血压很常见，分别发生在 68.5%和 38%的患者中。16.9%的患者收缩压≥160mmHg 或舒张压≥100mmHg。伊布替尼停药后高血压可逆转。年龄较大、男性、吸烟和慢性肾脏病与伊布替尼相关的高血压有关。基线高血压与伊布替尼治疗患者的主要不良心血管事件无关，也与无事件生存或总生存无关。
高血压是接受伊布替尼治疗的 CLL 患者的常见毒性，但大多数患者可进行管理。除慢性肾脏病外，基线心血管疾病并不影响伊布替尼相关的高血压，高血压也与主要不良心血管事件或生存无关。
