Results of active remote cardiac monitoring of oncohematological patients

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Abstract

BACKGROUND: Despite their targeted effects, targeted drug therapies also lead to adverse events, including various cardiac effects.

AIM: This study aims to determine the possibility of treating cardiovascular diseases underlying or occurring as a side effect of ibrutinib treatment without blocking targeted therapy for chronic lymphocytic leukemia (CLL).

MATERIALS AND METHODS: From 2016 to the present, we have examined and followed 217 patients with CLL who were continuously treated with ibrutinib targeted therapy for five years. The study included patients with CLL, aged 32 to 91 years [median age of 66.0 (32.0–91.0) years], including 136 men aged 66.0 (32.0–91.0) years and 81 women aged 65.0 (39.0–83.0) years. All patients underwent electrocardiography, echocardiography, 24-hour electrocardiographic Holter monitoring, 24-hour blood pressure monitoring, assessment of comorbidities using the Charlson Index, and screening for fragility using the G8 questionnaire.

RESULTS: Active cardiac monitoring, including continuous remote monitoring of cardioprotective therapy intake and efficiency, allows oncohematological patients to achieve higher overall survival rates. The long-term monitoring group included a statistically significant number of patients with atrial fibrillation and/or arterial hypertension and patients who receive dual and triple antithrombotic therapy. This group included patients with CLL and more severe cardiac status than other patients, who were regularly observed by a cardiologist.

CONCLUSIONS: Widespread introduction of the techniques for continuous remote monitoring of the oncological patient’s condition into clinical practice will improve the patients’ quality of life and increase their life expectancy.

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About the authors

Elena I. Emelina

N.I. Pirogov Russian National Research Medical University

Author for correspondence.
Email: eei1210@mail.ru
ORCID iD: 0000-0002-3100-8342

MD, Cand. Sci. (Med.)

Russian Federation, 1 Ostrovityanova str., 117997, Moscow

Gennady E. Gendlin

N.I. Pirogov Russian National Research Medical University

Email: rgmugt2@mail.ru
ORCID iD: 0000-0002-7846-1611

MD, Dr. Sci. (Med.), Professor

Russian Federation, 1 Ostrovityanova str., 117997, Moscow

Igor’ G. Nikitin

N.I. Pirogov Russian National Research Medical University

Email: igor.nikitin.64@mail.ru
ORCID iD: 0000-0003-1699-0881

MD, Dr. Sci. (Med.), Professor

Russian Federation, 1 Ostrovityanova str., 117997, Moscow

References

  1. Lenneman CG, Sawyer DB. Cardio-Oncology: An Update on Cardiotoxicity of Cancer-Related Treatment. Circ Res. 2016;118(6):1008–1020. doi: 10.1161/CIRCRESAHA.115.303633
  2. Chang HM, Okwuosa TM, Scarabelli T, et al. Cardiovascular Complications of Cancer Therapy: Best Practices in Diagnosis, Prevention, and Management: Part 2. J Am Coll Cardiol. 2017;70(20):2552–2565. doi: 10.1016/j.jacc.2017.09.1095
  3. Gribben JG, Bosch F, Cymbalista F, et al. Optimising outcomes for patients with chronic lymphocytic leukaemia on ibrutinib therapy: European recommendations for clinical practice. Br J Haematol. 2018;180(5):666–679. doi: 10.1111/bjh.15080
  4. Shatzel JJ, Olson SR, Tao DL, et al. Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies. J Thromb Haemost. 2017;15(5):835–847. doi: 10.1111/jth.13651
  5. Mulligan SP, Ward CM, Whalley D, Hilmer SN. Atrial fibrillation, anticoagulant stroke prophylaxis and bleeding risk with ibrutinib therapy for chronic lymphocytic leukaemia and lymphoproliferative disorders. Br J Haematol. 2016;175(3):359–364. doi: 10.1111/bjh.14321
  6. library.ehaweb.org [Internet]. Gendlin G, Emelina E, Nikitin I. Atrial fibrillation in patients with chronic lymphocytic leukemia receiving treatment with ibruthinib [cited 26 Feb 2021]. Available from: https://library.ehaweb.org/eha/2018/stockholm/216278/gennady.gendlin.atrial.fibrillation.in.patients.with.chronic.lymphocytic. html?f=menu=6*ce_id=1346*ot_id=19050*media=3
  7. Revishvili ASh, Rzaeva FG, Gorin MV, editors. Clinical recommendations: “diagnosis and treatment of atrial fibrillation” [Internet]. [cited 24 Feb 2021]. Available from: http://webmed.irkutsk.ru/doc/pdf/af.pdf.
  8. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–2962. doi: 10.1093/eurheartj/ehw210
  9. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736–2747. doi: 10.1161/CIRCULATIONAHA.110.009449
  10. Emelina E, Gendlin G, Nikitin I. P471Experience with the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation and a high risk of hemorrhagic complications. EP Europace. 2020;22(Supplement_1). doi: 10.1093/europace/euaa162.310
  11. Gribben JG, Bosch F, Cymbalista F, et al. Optimising outcomes for patients with chronic lymphocytic leukaemia on ibrutinib therapy: European recommendations for clinical practice. Br J Haematol. 2018;180(5):666–679. doi: 10.1111/bjh.15080
  12. Lopez-Fernandez T, Martin Garcia A, Santaballa Beltran A, et al. Cardio-Onco-Hematology in Clinical Practice. Position Paper and Recommendations. Rev Esp Cardiol (Engl Ed). 2017;70(6):474–486. doi: 10.1016/j.rec.2016.12.041
  13. Gendlin GE, Emelina EI, Nikitin IG. Anticoagulant Therapy in Patients with Chronic Lymphocytic Leukemia Receiving Ibrutinib. Hematological Oncology. 2019;37:383–384. doi: 10.1002/hon.52_2631
  14. Emelina EI, Gendlin GE, Nikitin IG. Antithrombotic therapy in patients with malignant lymphoproliferative disorders treated with ibrutinib. Klinicheskaia onkogematologiia. 2019;12(4):449–460. (In Russ). doi: 10.21320/2500-2139-2019-12-4-449-460/
  15. library.ehaweb.org [интернет]. Gendlin G, Emelina E, Nikitin I. The use of long-term antitrombotic therapy in patients with chronic lymphocytic leukemia treated with ibrutinib [cited 26 Feb 2021]. Available from: https://library.ehaweb.org/eha/2020/eha25th/294627/elena.emelina.the.use.of.long-term.antitrombotic.therapy.in.patients.with.html?f=menu%3D6%2Abrowseby%3D8%2Asortby%3D2%2Amedia%3D3%2Ace_id%3D1766%2Aot_id%3D23223%2Amarker%3D757%2Afeatured%3D16775.
  16. Emelina EI, Gendlin GE, Nikitin IG, et al. Rhythm and conduction disorders in patients treated with ibrutinib. Klinicheskaia onkogematologiia. 2019;12(2):220-230. (In Russ).
  17. library.ehaweb.org [Internet]. Emelina E, Gendlin G, Nikitin I. Rhythm and conduction disorders in patients with chronic lymphocytic leukemia receiving treatment with ibrutinib. [cited 26 Feb 2021]. Available from: https://library.ehaweb.org/eha/2019/24th/266194/elena.emelina.rhythm.and.conduction.disorders.in.patients.with.chronic.html?f=listing%3D3%2Abrowseby%3D8%2Asortby%3D1%2Amedia%3D1
  18. Gribben JG, Bosch F, Cymbalista F, et al. Optimising outcomes for patients with chronic lymphocytic leukaemia on ibrutinib therapy: European recommendations for clinical practice. Br J Haematol. 2018;180(5):666–679. doi: 10.1111/bjh.15080
  19. López-Fernández T, Canales M, Farmakis D, et al. Ibrutinib-Associated Atrial Fibrillation: A Practical Approach. Ann Hematol Oncol. 2018;5(4):1203.
  20. Lopez-Fernandez T, Martin Garcia A, Santaballa Beltran A, et al. Cardio-Onco-Hematology in Clinical Practice. Position Paper and Recommendations. Rev Esp Cardiol (Engl Ed). 2017;70(6):474–486. doi: 10.1016/j.rec.2016.12.041
  21. Chang HM, Okwuosa TM, Scarabelli T, et al. Cardiovascular Complications of Cancer Therapy: Best Practices in Diagnosis, Prevention, and Management: Part 2. J Am Coll Cardiol. 2017;70(20):2552–2565. doi: 10.1016/j.jacc.2017.09.1095
  22. Chang HM, Moudgil R, Scarabelli T, et al. Cardiovascular Complications of Cancer Therapy: Best Practices in Diagnosis, Prevention, and Management: Part 1. J Am Coll Cardiol. 2017;70(20):2536–2551. doi: 10.1016/j.jacc.2017.09.1096

Supplementary files

Supplementary Files
Action
1. Fig. 1. Frequency of atrial fibrillation in men and women: on and before ibrutinib therapy.

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2. Fig. 2. Comparison of the average daily systolic and diastolic blood pressure measurements in three groups of patients according to 24-hour blood pressure monitoring, where AH, arterial hypertension; SBP, systolic blood pressure; DBP, diastolic blood pressure; CLL, chronic lymphocytic leukemia.

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3. Fig. 3. Overall survival of patients with CLL in the active cardiac monitoring group compared with other patients with CLL; p <0,0001.

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