Clinical management of patients with chronic myelogenous leukemia (CML) who are receiving tyrosine kinase inhibitors (TKIs) may be improved by assessing ankle-brachial blood pressure index (ABI) and cardiac ankle vascular index (CAVI). These findings were published in the International Journal of Hematology.

TKIs have improved clinical outcomes for patients with CML; however, long-term TKI exposure has been associated with cardiovascular adverse events (CAEs). This study sought to assess whether evaluating patients for additional cardiovascular features may improve risk stratification.

Patient records from Osaka City University in Japan between 2017 and 2018 were retrospectively reviewed. Researchers assessed 74 patients with CML who were taking TKIs for clinical outcomes through 2020.

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Patients were median age 63.5 years (range, 21 to 91), 46 were men, 50.0% had hypertension, and 32.4% had dyslipidemia.

Median TKI duration was 7.84 years, and 2 were in the accelerated phase (CML-AP) of disease.

A total of 18 CAEs occurred while taking nilotinib (9), dasatinib (4), imatinib (3), and bosutinib (2).

More patients with CAEs exhibited QTc prolongation (87.5% vs 28.6%; P =.002), were women (70.0% vs 32.8%; P =.036), and had diabetes (50.0% vs 10.9%; P =.008).

Significant predictors of CAE included ABI ≤0.9 (odds ratio [OR], 20.3; P =.0005), ABI ≤0.9 or CAVI ≥9.0 (OR, 11.1; P =.0042), diabetes (OR, 8.14; P =.005), ABI <1.0 or CAVI ≥9.0 (OR, 6.67; P =.023), female sex (OR, 4.78; P =.034), ABI <1.0 (OR, 4.33; P =.039), and QTc value (OR, 1.05; P =.011).

The best predictive model included hypertension, diabetes, dyslipidemia, and ABI ≤0.9 or CAVI ≥9.0 with an area under the curve (AUC) of 0.830 (P =.047).

This study was limited as an abnormal ABI may affect the accuracy of CAVI.

These data indicated that ABI and CAVI assessment may allow for better risk stratification for CAE among patients with CML.

Disclosure: Multiple authors declared affiliation with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Nakamae M, Nakamae H, Hashimoto M, et al. Predictive value of clinical examination parameters for cardiovascular adverse events during treatment of chronic myeloid leukemia with tyrosine kinase inhibitors. Int J Hematol. Published online November 17, 2021. doi:10.1007/s12185-021-03259-8