Tyrosine kinase inhibitors (TKIs) have shown long-term survival benefits in chronic myeloid leukemia (CML) patients. Nevertheless, significant concern has been raised regarding long-term TKI-associated vascular adverse events (VAEs). The objective of this retrospective cohort study was to investigate the incidence of VAEs in Taiwanese CML patients treated with different TKIs (imatinib, nilotinib, and dasatinib) as well as potential risk factors.
We conducted a retrospective cohort study using the Taiwan Cancer Registry Database (TCRD) and National Health Insurance Research Database (NHIRD). Adult patients diagnosed with CML from 2008 to 2016 were identified and categorized into three groups according to their first-line TKI treatment (imatinib, nilotinib, and dasatinib). Propensity score matching was performed to control for potential confounders. Cox regressions were used to estimate the hazard ratio (HR) of VAEs in different TKI groups.
In total, 1,111 CML patients were included in our study. We found that the risk of VAEs in nilotinib users was significantly higher than that in imatinib users, with a hazard ratio (HR) of 3.13 (95% confidence interval (CI) 1.30-7.51), while dasatinib users also showed a nonsignificant trend for developing VAEs, with an HR of 1.71 (95%CI 0.71-4.26). In multivariable logistic regression analysis, only nilotinib usage, older age and history of cerebrovascular diseases were identified as significant risk factors. The annual incidence rate of VAEs was highest within the first year after the initiation of TKIs.
These findings can support clinicians in making treatment decisions and monitoring VAEs in CML patients in Taiwan.
Our study found that CML patients treated with nilotinib and dasatinib may exposed to higher risk of developing vascular adverse events compared to those who treated with imatinib. Thus, we suggest that CML patients who are older or have a history of cerebrovascular diseases should be under close monitoring of VAEs, particularly within the first year after the initiation of TKIs.

© AlphaMed Press 2021.