Abstract 11235: Echocardiographic Assessment of Cardiotoxicity in Chronic Myelogenous Leukemia Patients Receiving Dasatinib or Nilotinib

IntroductionTyrosine kinase inhibitors (TKIs) have improved the prognosis of chronic myelogenous leukemia (CML) but have recently been associated with cardiotoxicity. The risk and types of cardiotoxicity for most of these agents remain unknown.HypothesisWe aimed to evaluate the prevalence and degree of cardiotoxicity triggered by second generation TKIs in CML patients and to evaluate the need for systematic echocardiographic examination.MethodsThe medical records of all CML patients who received treatment with second generation TKIs (dasatinib or nilotinib) at our institution from 2000 to 2017 were reviewed. The patients were divided into 2 groups based on treatment history with dasatinib or nilotinib. Baseline demographics, comorbidities, first line cancer treatment, therapy duration, and transthoracic echocardiogram (TTE) findings prior, during, or after TKI therapy were analyzed via descriptive statistics.ResultsA total of 346 patients were diagnosed with CML and underwent chemotherapy with second generation TKIs between 2000 and 2017. Of these, 105 received nilotinib and 241 received dasatinib. In the nilotinib group, 25 (23.8%) patients were evaluated by TTE; serial TTE assessment (before, during, and after chemotherapy) was performed in 1 (4%) patient. In the dasatinib group, 211 (87.5%) patients were evaluated by TTE, of which 10 (4.7%) with serial TTE assessment. The prevalence of decreased left ventricular ejection fraction as measured on TTE during or after treatment was low (11 patients, 5%, with dasatinib and 1 patient, 4%, with nilotinib). Pulmonary hypertension was identified in 31 patients (14.7%) treated with dasatinib and in 3 patients (12%) with nilotinib, appearing early in the course of therapy. There was no significant change in the size of pericardial or pleural effusions while on therapy.ConclusionsWhile the occurrence of TKI-associated cardiotoxicity appears to be low, further studies are required to establish the impact of this adverse effect. As concern for cardiotoxicity is increasing, management should include serial TTE assessment (prior, during, and after treatment). A reliable, reproducible imaging protocol could decrease the number of random TTE studies and would move to clinically driven imaging.