Patients with chronic myeloid leukemia (CML) treated with a first- or second-generation tyrosine kinase inhibitor (TKI) may have an increased risk of arterial and venous vascular events, according to a study published in the Annals of Internal Medicine.1

Although the introduction of TKIs has dramatically improved survival and life expectancy of patients with CML, continuous administration of these agents may induce long-term toxicities. Researchers examined the incidence of vascular events in patients with CML treated with the first generation TKI, imatinib, and second-generation TKIs, nilotinib and dasatinib.

Of 896 enrolled patients with CML in chronic phase, 94.4% had documented treatment with a TKI. Patients were followed for a median of 4.2 years; results showed that 54 arterial (relative risk, 1.5; 95% CI, 1.1-2.1) and 20 venous events (relative risk, 2.0; 95% CI, 1.2-3.3) were reported in the cohort of patients with CML.

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Researchers also found that patients treated with second-generation TKIs had a higher rate of myocardial infarction, in contrast with those who received imatinib. More data are necessary, however, to determine whether the risk of myocardial infarction increases with use of nilotinib and dasatinib.

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Twenty-six of the 31 patients treated with a TKI who had a mydocardial infarction were diagnosed with at least 1 cardiac risk factor beforehand.

This study was limited by the inclusion of patients exposed to multiple TKIs. Data on second- and third-generation TKI were limited.


  1. Dahlen T, Edgren G, Lambe M, et al. Cardiovascular events associated with use of tyrosine kinase inhibitors in chronic myeloid leukemia: a population-based cohort study. Ann Intern Med. 2016 Jun 14. doi: 10.7326/M15-2306 [Epub ahead of print]