背景:酪氨酸激酶抑制剂(TKIs)已成为治疗慢性髓性白血病(CML)的主要药物,但与TKIs相关的心血管(CV)风险和潜在危险因素的恶化已引起广泛争论。现实世界的证据表明,在英国CML管理中很少使用CV危险因素筛查或持续监测。本共识文件提出了实用建议,以帮助医疗保健专业人员对接受TKIs的患者进行CV筛查/合并症管理。
方法:我们进行了一次多学科小组会议和两次迭代调查,涉及10名CML专家:5名血液学家。两位心血管肿瘤学家,一个血管外科医生,一名血液肿瘤药剂师和一名专科护士。
结果:专家组建议开始使用第二代/第三代TKI的患者在基线时接受正式的CV风险评估,对于那些具有高CV风险的人,需要心脏病专家/血管外科医生的额外调查和参与。治疗期间,患者应接受CV监测,测试的性质和频率取决于TKI和基线CV风险。对于出现CV不良事件的患者,围绕TKI中断的决策,停止或改变应该是多学科的,平衡CV和血液学风险。
结论:专家组预计这些建议将支持医疗保健专业人员实施CV风险筛查和监测,广泛而一致地,从而帮助优化TKI治疗CML。
BACKGROUND: Tyrosine kinase inhibitors (TKIs) have become the mainstay of treatment for chronic myeloid leukaemia (CML), but cardiovascular (CV) risk and exacerbation of underlying risk factors associated with TKIs have become widely debated. Real-world evidence reveals little application of CV risk factor screening or continued monitoring within UK CML management. This
consensus paper presents practical recommendations to assist healthcare professionals in conducting CV screening/comorbidity management for patients receiving TKIs.
METHODS: We conducted a multidisciplinary panel meeting and two iterative surveys involving 10 CML specialists: five haematologists, two cardio-oncologists, one vascular surgeon, one haemato-oncology pharmacist and one specialist nurse practitioner.
RESULTS: The panel recommended that patients commencing second-/third-generation TKIs undergo formal CV risk assessment at baseline, with additional investigations and involvement of cardiologists/vascular surgeons for those with high CV risk. During treatment, patients should undergo CV monitoring, with the nature and frequency of testing dependent on TKI and baseline CV risk. For patients who develop CV adverse events, decision-making around TKI interruption, cessation or change should be multidisciplinary and balance CV and haematological risk.
CONCLUSIONS: The panel anticipates these recommendations will support healthcare professionals in implementing CV risk screening and monitoring, broadly and consistently, and thereby help optimise TKI treatment for CML.