NDLI: Cardiovascular events in CML patients treated with Nilotinib: validation of the HFA-ICOS baseline risk score

Content Provider	Springer Nature : BioMed Central
Author	Fernando, Fiona Andres, Maria Sol Claudiani, Simone Kermani, Nazanin Zounemat Ceccarelli, Giulia Innes, Andrew J. Khan, Afzal Rosen, Stuart D. Apperley, Jane F. Lyon, Alexander R. Milojkovic, Dragana
Abstract	Background The therapeutic landscape of chronic myeloid leukaemia (CML) has been transformed by tyrosine kinase inhibitors (TKI). Nilotinib, showed higher rates of major molecular response than imatinib, however associated with higher cardiovascular (CV) toxicity. We sought to describe the CV events associated with nilotinib in a real-world population and assess the predictive value of the HFA-ICOS risk score. Methods The HFA-ICOS baseline risk was calculated for patients with CML treated with nilotinib beween 2006 and 2021. The primary end point was the incidence of all CV events. The secondary end point was the incidence of ischaemic events. Survival analysis evaluated the risk (hazard ratio [HR]) of events stratified by baseline risk category, whilst on nilotinib therapy. Results Two hundred and twenty-nine eligible patients were included. The incidence of CV events was 20.9% (95% CI: 15.7–26.2%) following a median duration of treatment of 34.4 months. The secondary end point occurred in 12.7% (95% CI: 8.4–16.9%) of the population. Patients with higher HFA-ICOS baseline score had higher rates of CV events (low: 11.2%, medium: 28.2% [HR: 2.51, 95% CI: 1.17–5.66], high/very high: 32.4% [HR: 3.57, 95% CI: 1.77–7.20]) and ischaemic events (low: 5.20%, medium: 17.9% [HR: 2.19, 95% CI: 0.97–4.96], high/very high: 21.6% [HR: 3.9, 95% CI: 1.91–7.89]). In patients who did not have a CV event, the median total dose at last follow up or cessation of nilotinib therapy was lower when compared to the total daily median dose of nilotinib in patients who had a CV event (450 mg vs. 600 mg, p = 0.0074). Conclusions The HFA-ICOS risk stratification tool is an efficient discriminator at low, medium and high/very high risk of developing cardiovascular events, with an overall positive trend towards increasing cardiotoxicity rates with rising risk catergories. This study provides evidence to support the use of this predictive tool in nilotinib treated patients.
Related Links	https://cardiooncologyjournal.biomedcentral.com/counter/pdf/10.1186/s40959-024-00245-x.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	20573804
DOI	10.1186/s40959-024-00245-x
Journal	Cardio-Oncology
Issue Number	1
Volume Number	10
Language	English
Publisher	BioMed Central
Publisher Date	2024-07-15
Access Restriction	Open
Subject Keyword	Oncology Cardiology Chronic myeloid leukaemia TKI Nilotinib CV toxicity Risk stratification
Content Type	Text
Resource Type	Article
Subject	Oncology Cardiology and Cardiovascular Medicine
Journal Impact Factor	3.2/2023

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