Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy.
Hematology Unit, Sant'Eugenio Hospital Tor Vergata University, Rome, Italy.
Ann Hematol. 2024 Feb;103(2):427-436. doi: 10.1007/s00277-023-05556-0. Epub 2023 Nov 28.
Patients with chronic myeloid leukemia (CML) treated with nilotinib or ponatinib may experience arterial occlusive events (AOEs). It is currently recommended to thoroughly assess cardiovascular risk factors before treating CML. We identified 455 consecutive CML adult patients, 335 treated with nilotinib and 120 with ponatinib; 380 patients without previous cardiovascular diseases or diabetes were stratified according to the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Older Persons (SCORE2-OP). This updated algorithm from the European Society of Cardiology (ESC) estimates a 10-year risk of fatal and non-fatal cardiovascular diseases. It is based on sex, age, smoking habits, systolic blood pressure, non-high-density lipoprotein cholesterol, and European geographical region of cardiovascular risk. The SCORE2/SCORE2-OP algorithm translated more patients (50.2%) to the high-very high cardiovascular risk category than the previous SCORE (25.3%). Patients with a high to very high SCORE2/SCORE2-OP risk showed a significantly higher incidence rate of AOEs (69.2% vs. 46.5%, p < 0.001). The older SCORE was less specific in estimating AOEs in patients classified as low-intermediate risk (69.8 vs. 54.2%). In multivariate analysis, no associations were found between AOEs and gender, age, and type or dose of tyrosine kinase inhibitor. Only the SCORE2/SCORE2-OP risk was confirmed as a significant predictive factor (p = 0.028; hazard ratio = 2.2; 95% confidence interval = 1.1-4.5). Patients with AOEs required, in most cases, imaging diagnostic tests, additional drugs, and sometimes invasive procedures, increasing access to visits and hospital management. This real-life study suggested that the SCORE2 and SCORE2-OP charts could help identify cardiovascular fragility in CML patients providing them with more attention and a proper TKI selection.
接受尼洛替尼或波那替尼治疗的慢性髓性白血病（CML）患者可能会发生动脉闭塞性事件（AOEs）。目前建议在治疗 CML 之前彻底评估心血管危险因素。我们确定了 455 例连续的 CML 成年患者，其中 335 例接受尼洛替尼治疗，120 例接受波那替尼治疗；根据系统性冠状动脉风险评估（SCORE2）和 SCORE2-老年人（SCORE2-OP）对 380 例无既往心血管疾病或糖尿病的患者进行分层。欧洲心脏病学会（ESC）的这个更新算法估计了致命和非致命心血管疾病的 10 年风险。它基于性别、年龄、吸烟习惯、收缩压、非高密度脂蛋白胆固醇和心血管风险的欧洲地理区域。SCORE2/SCORE2-OP 算法将更多患者（50.2%）划分为高-极高心血管风险类别，而之前的 SCORE 为 25.3%。SCORE2/SCORE2-OP 风险较高的患者发生 AOEs 的发生率明显更高（69.2% vs. 46.5%，p < 0.001）。在分类为低-中危风险的患者中，较老的 SCORE 在估计 AOEs 方面的特异性较低（69.8% vs. 54.2%）。多变量分析未发现 AOEs 与性别、年龄以及酪氨酸激酶抑制剂的类型或剂量之间存在关联。只有 SCORE2/SCORE2-OP 风险被确认为显著预测因素（p = 0.028；危险比 = 2.2；95%置信区间 = 1.1-4.5）。发生 AOEs 的患者大多数需要进行影像学诊断检查、额外的药物治疗，有时还需要进行侵入性程序，这增加了就诊和医院管理的机会。这项真实世界的研究表明，SCORE2 和 SCORE2-OP 图表可以帮助识别 CML 患者的心血管脆弱性，为他们提供更多关注和适当的 TKI 选择。
