From: Tyrosine kinase inhibitor associated vascular toxicity in chronic myeloid leukemia
Strategy | Comments |
---|---|
1. Prevention and risk assessment | Â |
 Cardiovascular risk scoring for VAE risk stratification | a) For example, the European Society of Cardiology (ESC) 2012 classification b) Reliability of such a stratification in guiding TKI drug choice is uncertain |
 Atherosclerosis risk factor monitoring and management (hypertension, diabetes mellitus, dyslipidemia, smoking etc.) | a) Use of accepted guidelines b) Especially important for nilotinib and ponatinib |
 Echocardiogram | Especially relevant for dasatinib as PAH screening |
2. Monitoring tools | Â |
 Periodic cardiovascular risk score |  |
 Atherosclerosis risk factor surveillance (hypertension, diabetes, dyslipidemia, smoking etc.) |  |
 Subclinical radiological and/or laboratory markers | a) May include ABI, US Doppler of selected blood vessels, IMT measurement b) Clinical implication still investigational. c) ABI is the most commonly used screening measure in clinical practice |
3. Treatment | Â |
 Specific treatment for vascular toxicity | Interdisciplinary approach (vascular surgeons, cardiologists/neurologists) |
 CML treatment modification options: | Factors to be considered: |
a) Drug continuation with increased vigilance b) Drug discontinuation, choosing different TKI c) Dose reduction | a) Patient-related factors b) VAE-related factors c) Disease-related factors |