Contributions
Abstract: EP641
Type: E-Poster Presentation
Session title: Chronic lymphocytic leukemia and related disorders - Clinical
Background
The effect of anticancer drugs on the systolic function of the left ventricular (LV) myocardium determines the prognosis and survival of patients (pts). The systolic function of the LV myocardium in pts with chronic lymphocytic leukemia (CLL) treated with ibrutinib (Ib) has not been sufficiently studied.
Aims
Evaluate LV myocardial systolic function in pts with CLL receiving Ib.
Methods
We examined 227 pts with CLL in dynamics, receiving Ib, at the age of 66.0 (32.0-91.0) years, among which 144 men at the age of 66.0 (32.0-91.0) years and 83 women at the age 65.0 (39.0-83.0) years. We examined 116 pts before the start of Ib therapy and after 3-30 months, median 15.0 (10.0-21.0) months of Ib treatment. Other111 pts at the time of the first examination had already received Ib for 9.0 (6.0-14.0) months, they were also examined in dynamics: the interval between visits 1 and 2 was from 3 to 32 months, the median was 15.0 (10.0-23.5) months. All pts underwent echocardiography (Echo) with tissue Doppler at 2 follow-up visits. Indicators of LV systolic function were compared as dependent and independent values.
Results
In a longitudinal comparison, patients at visit 2 (n = 125) showed a decrease in the ejection fraction (EF) from 68.3 (63.4-72.7)% to 66.9 (62.4-70.9)% Simpson (p = 0.024). We separately analyzed changes in systolic function in pts with baseline EF greater than / equal to 60% (n = 112). In this pts group, there was also a decrease in EF from 69.5 (58.4-82.5)% to 67.2 (51.7-84.5)% according to Simpson (p = 0.004), which indicates a clear trend towards decrease in systolic function of the LV myocardium. When comparing Echo parameters as independent values in pts treated with Ib (n = 111) with pts before Ib treatment, an increase in the indexed end diastolic volume (iEDV) and the indexed end sistolic volume (iESV) was noted. Thus, in the pts group receiving Ib, iEDV was 55.1 (47.3-64.7) ml versus 49.8 (44.1-59.4) ml in patients before Ib treatment (p = 0.01), iESV in pts receiving Ib 17.7 (13.5-22.8) ml versus 15.8 (12.1-20.1) ml in pts before starting Ib treatment (p = 0.04). Probably, the tendency to dilatation of the LV chamber leads to a gradual decrease in LV systolic function and, under certain conditions, to a sharp decrease in EF. Thus, we encountered a sharp drop in EF in a 74-year-old patient who was added obinutuzumab to Ib. A previously stable patient after 4 injections of obinutuzumab developed heart failure with severe dyspnea at the level of functional class 3, a sharp decrease in EF from 58.1% to 35.2%, dilatation of the LV cavity - the end-diastolic volume increased from 119.7 ml to 165. 0 ml. Thus, it should be borne in mind that the combination of Ib with anticancer drugs affecting cardiomyocytes can lead to a sharp drop in EF with the development of severe heart failure.
Conclusion
In patients with CLL receiving ibrutinib, there is a tendency towards a decrease in systolic LV myocardial function. An increase in the LV cavity in patients with CLL, taking Ib, may be one of the reasons for a decrease in systolic LV myocardial function.The use of Ib with other antineoplastic drugs that affect the systolic function of the myocardium can lead to a sharp drop in the LV ejection fraction and the development of severe heart failure. Probably, in patients taking Ib, the vulnerability of myocardial systolic function and sensitivity to the effects of various agents on cardiomyocytes is formed.
Keyword(s): Chronic lymphocytic leukemia, Ibrutinib
Abstract: EP641
Type: E-Poster Presentation
Session title: Chronic lymphocytic leukemia and related disorders - Clinical
Background
The effect of anticancer drugs on the systolic function of the left ventricular (LV) myocardium determines the prognosis and survival of patients (pts). The systolic function of the LV myocardium in pts with chronic lymphocytic leukemia (CLL) treated with ibrutinib (Ib) has not been sufficiently studied.
Aims
Evaluate LV myocardial systolic function in pts with CLL receiving Ib.
Methods
We examined 227 pts with CLL in dynamics, receiving Ib, at the age of 66.0 (32.0-91.0) years, among which 144 men at the age of 66.0 (32.0-91.0) years and 83 women at the age 65.0 (39.0-83.0) years. We examined 116 pts before the start of Ib therapy and after 3-30 months, median 15.0 (10.0-21.0) months of Ib treatment. Other111 pts at the time of the first examination had already received Ib for 9.0 (6.0-14.0) months, they were also examined in dynamics: the interval between visits 1 and 2 was from 3 to 32 months, the median was 15.0 (10.0-23.5) months. All pts underwent echocardiography (Echo) with tissue Doppler at 2 follow-up visits. Indicators of LV systolic function were compared as dependent and independent values.
Results
In a longitudinal comparison, patients at visit 2 (n = 125) showed a decrease in the ejection fraction (EF) from 68.3 (63.4-72.7)% to 66.9 (62.4-70.9)% Simpson (p = 0.024). We separately analyzed changes in systolic function in pts with baseline EF greater than / equal to 60% (n = 112). In this pts group, there was also a decrease in EF from 69.5 (58.4-82.5)% to 67.2 (51.7-84.5)% according to Simpson (p = 0.004), which indicates a clear trend towards decrease in systolic function of the LV myocardium. When comparing Echo parameters as independent values in pts treated with Ib (n = 111) with pts before Ib treatment, an increase in the indexed end diastolic volume (iEDV) and the indexed end sistolic volume (iESV) was noted. Thus, in the pts group receiving Ib, iEDV was 55.1 (47.3-64.7) ml versus 49.8 (44.1-59.4) ml in patients before Ib treatment (p = 0.01), iESV in pts receiving Ib 17.7 (13.5-22.8) ml versus 15.8 (12.1-20.1) ml in pts before starting Ib treatment (p = 0.04). Probably, the tendency to dilatation of the LV chamber leads to a gradual decrease in LV systolic function and, under certain conditions, to a sharp decrease in EF. Thus, we encountered a sharp drop in EF in a 74-year-old patient who was added obinutuzumab to Ib. A previously stable patient after 4 injections of obinutuzumab developed heart failure with severe dyspnea at the level of functional class 3, a sharp decrease in EF from 58.1% to 35.2%, dilatation of the LV cavity - the end-diastolic volume increased from 119.7 ml to 165. 0 ml. Thus, it should be borne in mind that the combination of Ib with anticancer drugs affecting cardiomyocytes can lead to a sharp drop in EF with the development of severe heart failure.
Conclusion
In patients with CLL receiving ibrutinib, there is a tendency towards a decrease in systolic LV myocardial function. An increase in the LV cavity in patients with CLL, taking Ib, may be one of the reasons for a decrease in systolic LV myocardial function.The use of Ib with other antineoplastic drugs that affect the systolic function of the myocardium can lead to a sharp drop in the LV ejection fraction and the development of severe heart failure. Probably, in patients taking Ib, the vulnerability of myocardial systolic function and sensitivity to the effects of various agents on cardiomyocytes is formed.
Keyword(s): Chronic lymphocytic leukemia, Ibrutinib