Contributions
Abstract: EP653
Type: E-Poster Presentation
Session title: Chronic lymphocytic leukemia and related disorders - Clinical
Background
One of the possible cardiotoxic effects of ibrutinib (Ib) is the induction of arterial hypertension (AH). In addition, some patients (pts) who are assigned Ib already have hypertension. Poorly managed hypertension may have a direct impact on the prognosis and survival of pts with CLL receiving Ib.
Aims
To assess the manageability of hypertension and the effectiveness of antihypertensive therapy in pts with chronic lymphocytic leukemia (CLL), receiving Ib.
Methods
We conducted a prospective study for 56 months with the inclusion of 217 pts with CLL receiving AH-inducing Ib. In 116 (53.5%) pts AH was diagnosed before Ib therapy, in 24 (11.1%) pts AH occurred during Ib treatment. Out of 140 pts with AH: grade 1 - 15 pts (10.7%), grade 2 - 41 pts (29.3%), grade 3 - 84 pts (60%). Among pts with CLL and AH there were 86 men aged 67.0 (60.0-72.0) years and 59 women aged 67.0 (59.0-74.0) years.
As part of a comparative analysis, a 24-hour blood pressure monitor (24h-BPM) was carried out in dynamics against the background of antihypertensive therapy in three groups of pts: with CLL and AH receiving Ib (n=140) and pts with AH without cancer receiving AH treatment on an outpatient basis (n=159) and in a hospital (n=100). Pts did not have significant differences in age and sex composition. All pts received antihypertensive therapy, while the pts group with CLL and hypertension was under our distant controlled treatment. Combined antihypertensive therapy was required in 40.8% of patients with CLL and AH: a combination of 2 drugs - 54.9%, of 3 drugs - 33.3%, of 4 drugs - 9.8%. Pts in the comparison groups received antihypertensive therapy prescribed by the doctors of the hospital and polyclinics. Comparison of blood pressure (BP) indicators in dynamics according to 24h-BPM data in pts with CLL and AH receiving Ib was carried out, as well as comparison in the three indicated groups.
Results
During the observation period in pts with CLL and AH receiving Ib, we managed to achieve an effective decrease in blood pressure on our antihypertensive therapy: according to the control 24h-BPM, the 24-hour average systolic blood pressure (24-SBP) significantly decreased (p=0.009), 24-hour average diastolic blood pressure (24-DBP) (p=0.014), hypertensive time index (HTI) of SBP (p=0.006) and DBP (p=0.009) in waking period and in sleep period HTI of SBP (p=0.046) and DBP (p=0.008). When compared in 3 groups: pts with CLL and AH receiving Ib showed a more significant decrease in 24-SBP, 24-DBP (p=0.001) and HTI during wakefulness and sleep (p <0.0001) compared with pts in the population. Target blood pressure in the pts group with CLL and AH was achieved significantly more often than in the population (p <0.0001). In pts with CLL and AH on the background of antihypertensive therapy, significantly less pts with an unfavorable daily night picker profile (p=0.0003). Pts with CLL and AH, who received angiotensin-converting enzyme (ACE) inhibitors, had better overall survival, which was not observed with other antihypertensive drugs (p=0.001).
Conclusion
Despite the possible induction of hypertension by Ib, in pts with CLL treated with Ib, it is possible to achieve an effective reduction in blood pressure on antihypertensive therapy. To control AH 40.8% pts with CLL and AH, combination therapy with a predominance of two-component therapy is required. Pts with CLL and AH taking ACE inhibitors have higher overall survival rates compared to pts with CLL who did not receive this group of drugs.
Keyword(s): Chronic lymphocytic leukemia, Ibrutinib
Abstract: EP653
Type: E-Poster Presentation
Session title: Chronic lymphocytic leukemia and related disorders - Clinical
Background
One of the possible cardiotoxic effects of ibrutinib (Ib) is the induction of arterial hypertension (AH). In addition, some patients (pts) who are assigned Ib already have hypertension. Poorly managed hypertension may have a direct impact on the prognosis and survival of pts with CLL receiving Ib.
Aims
To assess the manageability of hypertension and the effectiveness of antihypertensive therapy in pts with chronic lymphocytic leukemia (CLL), receiving Ib.
Methods
We conducted a prospective study for 56 months with the inclusion of 217 pts with CLL receiving AH-inducing Ib. In 116 (53.5%) pts AH was diagnosed before Ib therapy, in 24 (11.1%) pts AH occurred during Ib treatment. Out of 140 pts with AH: grade 1 - 15 pts (10.7%), grade 2 - 41 pts (29.3%), grade 3 - 84 pts (60%). Among pts with CLL and AH there were 86 men aged 67.0 (60.0-72.0) years and 59 women aged 67.0 (59.0-74.0) years.
As part of a comparative analysis, a 24-hour blood pressure monitor (24h-BPM) was carried out in dynamics against the background of antihypertensive therapy in three groups of pts: with CLL and AH receiving Ib (n=140) and pts with AH without cancer receiving AH treatment on an outpatient basis (n=159) and in a hospital (n=100). Pts did not have significant differences in age and sex composition. All pts received antihypertensive therapy, while the pts group with CLL and hypertension was under our distant controlled treatment. Combined antihypertensive therapy was required in 40.8% of patients with CLL and AH: a combination of 2 drugs - 54.9%, of 3 drugs - 33.3%, of 4 drugs - 9.8%. Pts in the comparison groups received antihypertensive therapy prescribed by the doctors of the hospital and polyclinics. Comparison of blood pressure (BP) indicators in dynamics according to 24h-BPM data in pts with CLL and AH receiving Ib was carried out, as well as comparison in the three indicated groups.
Results
During the observation period in pts with CLL and AH receiving Ib, we managed to achieve an effective decrease in blood pressure on our antihypertensive therapy: according to the control 24h-BPM, the 24-hour average systolic blood pressure (24-SBP) significantly decreased (p=0.009), 24-hour average diastolic blood pressure (24-DBP) (p=0.014), hypertensive time index (HTI) of SBP (p=0.006) and DBP (p=0.009) in waking period and in sleep period HTI of SBP (p=0.046) and DBP (p=0.008). When compared in 3 groups: pts with CLL and AH receiving Ib showed a more significant decrease in 24-SBP, 24-DBP (p=0.001) and HTI during wakefulness and sleep (p <0.0001) compared with pts in the population. Target blood pressure in the pts group with CLL and AH was achieved significantly more often than in the population (p <0.0001). In pts with CLL and AH on the background of antihypertensive therapy, significantly less pts with an unfavorable daily night picker profile (p=0.0003). Pts with CLL and AH, who received angiotensin-converting enzyme (ACE) inhibitors, had better overall survival, which was not observed with other antihypertensive drugs (p=0.001).
Conclusion
Despite the possible induction of hypertension by Ib, in pts with CLL treated with Ib, it is possible to achieve an effective reduction in blood pressure on antihypertensive therapy. To control AH 40.8% pts with CLL and AH, combination therapy with a predominance of two-component therapy is required. Pts with CLL and AH taking ACE inhibitors have higher overall survival rates compared to pts with CLL who did not receive this group of drugs.
Keyword(s): Chronic lymphocytic leukemia, Ibrutinib