Cardiovascular Risks More Common With Newer TKI Chemotherapeutics for CML Interview with:
Torsten Dahlén MD
Centre for Hematology
Karolinska University Hospital Solna
Stockholm Sweden What is the background for this study? 

Dr. Dahlén: Patients diagnosed with CML have had a dramatic increase in life-expectancy since the widespread introduction of tyrosine kinase inhibitors (TKI) in 2001. However, treatment is today regarded as life-long. We thus need to observe for late-effects of continuous TKI exposure. Recent reports have demonstrated a linkage between TKI treatment, especially more potent 2nd and 3rd generation drugs, and to the occurrence of peripheral arterial occlusive disease (PAOD). This study aimed to use real-world data utilizing Swedish population based registries together with the dedicated Swedish CML registry which contains data and follow-up on more than 98% of all CML patients diagnosed in Sweden since 2002. What are the main findings?

Dr. Dahlén: We compared an cohort of age- and sex-matched people to a cohort of CML-patients in regards to the occurrence of myocardial infarction, cerebrovascular disease, other arterial thrombosis, deep venous thrombosis and pulmonary embolism. We showed that deep venous thrombosis, other arterial thrombosis and myocardial infarction was more common in CML patients compared to the controls. When comparing the different TKIs on the market between 2002 and 2012 we also saw a tendency to increased risks of the above events with usage of 2nd generation TKIs (nilotinib and dasatinib) as compared to the 1st generation drug imatinib. What should readers take away from your report?

Dr. Dahlén:  Patients with CML should be closely monitored in regards to long-term effects of TKI treatment and patients with risk-factors for cardiovascular disease should be handled with caution, focusing on both preventive measures but also in regards to the choice of TKI. What recommendations do you have for future research as a result of this study?

Dr. Dahlén:  We need to further investigate the effects of the 2nd generation TKIs, both in the population-based setting to estimate risks with treatment, but also to find the underlying mechanisms of how TKIs may promote cardiovascular disease. Thank you for your contribution to the community.


Dahlén T, Edgren G, Lambe M, Höglund M, Björkholm M, Sandin F, et al. Cardiovascular Events Associated With Use of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Population-Based Cohort Study. Ann Intern Med. [Epub ahead of print 14 June 2016] doi:10.7326/M15-2306

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Last Updated on June 15, 2016 by Marie Benz MD FAAD