Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib

Cardio-Oncology

Wei Fang¹  Christopher Bianco²  Brijesh Patel²  Kelly Ross³  Abraham Kanate³  Lauren Veltri³  Michael Craig³  Midhun Malla³  Juan Carlo Avalon⁴  Jacob Fuqua⁴  Chelby Wakefield⁴  Austin King⁴  Seth Deskins⁴  Sonya Inderbitzin-Brooks⁴  Tyler Miller⁴ 

[1] West Virginia Clinical and Translational Science Institute, Morgantown, USA;West Virginia University Heart and Vascular Institute, 26506, Morgantown, WV, USA;West Virginia University Mary Babb Randolph Cancer Institute, Morgantown, USA;West Virginia University School of Medicine, Morgantown, USA;

关键词: Ibrutinib;    Atrial fibrillation;    Cardio-oncology;    Cardiovascular disease;    Arrhythmia;    Hematologic malignancy;   

DOI  :  10.1186/s40959-021-00125-8

来源: Springer

【 摘 要 】

BackgroundIbrutinib is a Bruton’s tyrosine kinase inhibitor used in the treatment of hematological malignancies. The most common cardiotoxicity associated with ibrutinib is atrial arrhythmia (atrial fibrillation and flutter). It is known that patients with cardiovascular disease (CVD) are at an increased risk for developing atrial arrhythmia. However, the rate of atrial arrhythmia in patients with pre-existing CVD treated with ibrutinib is unknown.ObjectiveThis study examined whether patients with pre-existing CVD are at a higher risk for developing atrial arrhythmias compared to those without prior CVD.MethodsA single-institution retrospective chart review of patients with no prior history of atrial arrhythmia treated with ibrutinib from 2012 to 2020 was performed. Patients were grouped into two cohorts: those with CVD (known history of coronary artery disease, heart failure, pulmonary hypertension, at least moderate valvular heart disease, or device implantation) and those without CVD. The primary outcome was incidence of atrial arrhythmia, and the secondary outcomes were all-cause mortality, risk of bleeding, and discontinuation of ibrutinib. The predictors of atrial arrhythmia (namely atrial fibrillation) were assessed using logistic regression. A Cox-Proportional Hazard model was created for mortality.ResultsPatients were followed for a median of 1.1 years. Among 217 patients treated with ibrutinib, the rate of new-onset atrial arrhythmia was nearly threefold higher in the cohort with CVD compared to the cohort without CVD (17% vs 7%, p = 0.02). Patients with CVD also demonstrated increased adjusted all-cause mortality (OR 1.9, 95% CI 1.06-3.41, p = 0.01) and decreased survival probability (43% vs 54%, p = 0.04) compared to those without CVD over the follow-up period. There were no differences in risk of bleeding or discontinuation between the two cohorts.ConclusionsPre-existing cardiovascular disease was associated with significantly higher rates of atrial arrhythmia and mortality in patients with hematological malignancies managed with ibrutinib.

【 授权许可】

CC BY