Assessment of the risk of vascular adverse events by Doppler ultrasound in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors: a case control study

Abstract

Objective
Chronic myeloid leukemia (CML) is the first human malignancy that is responded to molecular targeted therapy, tyrosine kinase inhibitors (TKIs). Despite the strong effect of TKIs on the management and outcome of CML, several adverse events have been reported. Vascular arterial adverse events (VAEs) are serious complications reported with new-generation TKIs.


Patient and methods
We conducted a case-control study including 70 CML patients who were receiving either imatinib or nilotinib and 50 age- and sex-matched controls to assess the effect of TKI use on the vascular wall by variety-coded Doppler ultrasound.


Results
The radial and ulnar intima media thickness (IMT) were significantly greater in patients than in controls (P=<0.001 and 0.015, respectively). There was also a significant increase in the anterior tibial artery IMT, posterior tibial artery IMT, and posterior tibial artery peak systolic velocity in patients compared with controls (P values=0.005, 0.011, and 0.007, respectively). The ulnar IMT was significantly greater in patients receiving imatinib than in those receiving nilotinib (P>0.05). We also found that the duration of TKI intake was correlated with the middle cerebral artery pulsatile index (r=0.274, P=0.021).


Conclusion
The use of TKIs (imatinib and nilotinib) is associated with arterial vascular wall effects that may lead to VAEs. Close monitoring of the other risk factors for VAEs as well as atrial duplex after the initiation of TKIs is warranted.