Chronic myeloid leukemia, tyrosine kinase inhibitors and cardiovascular system

OBJECTIVE: Cardiovascular sys-tem health becomes important with the extend-ed survival of chronic myeloid leukemia (CML) patients. Cardiotoxicities are related to the sec- ond-and third-generation tyrosine kinase inhib-itors (TKIs). The most frequent and important cardiovascular events are myocardial infarction, stroke and peripheral arterial disease, QT pro-longation, pleural effusions, and both system-ic and pulmonary hypertension. The aim of this paper is to review the interactions between ad-ministrated TKIs and the cardiovascular system during the clinical course of CML. Elucidation of TKI effects on the cardiovascular system is vital since the current goal of CML therapy is a cure that leads to normal age and gender-similar sur-vival with a normal quality of life.MATERIALS AND METHODS: Up to August 2022, literature searches were performed via the internet search engines MEDLINE, EMBASE, GOOGLE SCHOLAR: (i) chronic myeloid leuke-mia; (ii) tyrosine kinase inhibitor; (iii) cardiovascu-lar system. Only articles in English and research including humans were included in the search.RESULTS: Tailored TKI treatment with individ-ual patient characteristics must account for CML disease risk, patient age, patient comorbidities, patient compliance, TKI drug off-target risk pro-file, accelerated or blastic phase CML disease, pregnancy and allografting in CML. The treat-ment-free survival, improving quality of life, limit-ing adverse events of TKIs, and the optimal dose and administration duration of TKIs are still a matter of controversy. Special attention should be paid to the comorbidities of CML patients and clinical TKI effects on CVS since the aim of CML treatment is a cure that leads to normal age and gender-similar survival with a "normal" quality of life. CVS is an important morbidity and mortality cause for adult patients. The discontinuation of TKI treatment in CML and the treatment-free re-mission of CML patients are very important in or-der to reduce the risk for cardiovascular adverse effects of TKIs. The frail CML patients and espe-cially the patients who have cardiac comorbidi-ties, should be carefully evaluated for TKI treat-ment, and hematopoietic stem cell transplanta-tion (HSCT) should be the last choice in these risky CML patients.CONCLUSIONS: The current CML treatment target is a cure that leads to normal age and gen-der-adjusted survival with a "normal" quality of life. Cardiovascular disorders are one of the ma-jor obstacles to reaching this target in CML pa-tients. The treatment choices for CML patients must include a cardiovascular perspective.