International consensus statement on the management of cardiovascular risk of Bruton’s tyrosine kinase inhibitors in CLL

Farrukh T. Awan, Daniel Addison, Feras Alfraih, Sergio J. Baratta, Rodrigo Noronha Campos, María Silvana Cugliari, Yeow Tee Goh, Valery Alexandrovich Ionin, Stefanie Mundnich, Aaron L. Sverdlov, Constantine Tam, Loïc Ysebaert

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Bruton’s tyrosine kinase inhibitors (BTKis) have altered the treatment landscape for chronic lymphocytic leukemia (CLL) by offering effective and well-tolerated therapeutic options. However, since the approval of ibrutinib, concern has risen regarding the risk of cardiovascular (CV) adverse events, including atrial fibrillation (AF), hypertension, and heart failure. Newer BTKis appear to have lower CV risks, but data are limited. It is important to understand the risks posed by BTKis and how those risks interact with individual patients, and we convened a panel of physicians with expertise in CLL and CV toxicities in oncology to develop evidence-based consensus recommendations for community hematologists and oncologists. Care providers should thoroughly assess a patient’s CV risk level before treatment initiation, including established CV diseases and risk factors, and perform investigations dependent on preexisting diseases and risk factors, including an electrocardiogram (ECG). For patients with high CV risk, BTKi treatment is often appropriate in consultation with a multidisciplinary team (MDT), and more selective BTKis, including acalabrutinib and zanubrutinib, are preferred. BTKi treatment should generally be avoided in patients with a history of heart failure. Ibrutinib should be avoided in patients with a history of ventricular arrhythmias, but the risk of newer drugs is not yet known. Finally, an MDT is crucial to help manage emerging toxicities with the goal of maintaining BTKi therapy, if possible. Optimizing heart failure, arrhythmia, and hypertension control will likely improve tolerance and maintenance of BTKi therapy. However, additional studies are needed to identify the most optimal strategy for these drugs.

Original languageEnglish (US)
Pages (from-to)5516-5525
Number of pages10
JournalBlood Advances
Issue number18
StatePublished - Sep 27 2022

ASJC Scopus subject areas

  • Hematology


Dive into the research topics of 'International consensus statement on the management of cardiovascular risk of Bruton’s tyrosine kinase inhibitors in CLL'. Together they form a unique fingerprint.

Cite this