The effect of tyrosine kinase inhibitors used in the treatment of chronic myeloid leukemia on the cardiovascular system

The use of tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia has significantly improved the prognosis and outcomes for most patients. Clinical trials indicate that long-term CML therapy requires the introduction of second- or third-generation inhibitors in approximately 40–50% of cases. Effective in the event of imatinib resistance or intolerance, the drugs can also be used as a first- -line treatment, leading to a faster, deeper molecular response than imatinib in a greater proportion of patients, and thus creating a greater chance for long-term treatment-free remission. TKIs, however, have also been observed to cause significant late adverse effects, including cardiovascular complications, which may raise certain safety concerns. The excellent treatment outcomes achieved with tyrosine kinase inhibitors have led to a gradual increase in the number and age of treated patients, and the associated higher incidence and severity of age-related co-morbidities such as diabetes, hypercholesterolemia, atherosclerosis, ischemic heart disease, hypertension, and congestive heart failure, which raise the risk of treatment-related cardiovascular complications. The article discusses the effects of individual TKIs on the pathogenesis of cardiovascular complications and presents the results of clinical trials that studied their impact on the incidence of such events.