Patients with chronic myeloid leukemia (CML) who are receiving tyrosine kinase inhibitor (TKI) therapy should be evaluated for pulmonary hypertension (PH), according to results of a retrospective analysis published in Medicine.
The TKI dasatinib has been associated with PH, but published data about other TKIs are scarce. To assess for a possible link between PH and all TKIs, researchers from Chungnam National University College of Medicine in South Korea reviewed their institutional records from 2003 to 2020 and identified 112 patients with CML who received TKI therapy and underwent transthoracic echocardiographic examination (TTE).
Patients were median age 54 years (range, 13 to 81), 58.9% were men, and TKIs were the first line of treatment for 76.8%. The TKIs included imatinib (35.7%), dasatinib (33.0%), nilotinib (28.6%), radotinib (1.8%), and ponatinib (0.9%).
A total of 12 (10.7%) patients were found to have TKI treatment-related PH, and 2 (1.8%) who had left heart failure-associated PH were excluded from the analyses.
Compared with patients without PH, those with PH were older (median, 66.5 vs 57.5 years; P =.001); more patients with PH were observed to have chronic kidney disease (58.3% vs 16.0%; P =.003); and more patients with PH were treated with dasatinib (66.7% vs 29.0%; P =.009).
Significant risk factors for PH included cardiopulmonary symptoms (odds ratio [OR], 36.1; 95% CI, 5.3-247.3; P =.001), aged older than 60 years (OR, 12.3; 95% CI, 1.1-142.1; P =.04), and dasatinib therapy (OR, 8.2; 95% CI, 1.3-50.6; P =.03).
This study was limited because whether PH symptoms were present before the use of TKIs remains unclear.
These data indicated that patients who received dasatinib were at increased risk for PH. The condition was also observed in 3 patients who received imatinib and 1 patient who received nilotinib, which may indicate that all patients receiving TKIs for CML are at increased risk for PH.
Song IC, Yeon SH, Lee MW, et al. Pulmonary hypertension in patients with chronic myeloid leukemia. Medicine. 2021;100(33):e26975. doi:10.1097/MD.0000000000026975