Cardiac Adverse Events in Patients With Chronic Lymphocytic Leukemia Treated With First-Line Ibrutinib-Venetoclax.
Liron Hofstetter, Shira Buchrits, Adi Sherban et al.
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In 30 seconds
This systematic review and meta-analysis assessed cardiac adverse events with first-line ibrutinib-venetoclax (IV)-based therapy for chronic lymphocytic leukemia or small lymphocytic lymphoma. Fourteen publications involving 1,522 patients contributed to pooled incidence estimates, and four randomized trials informed comparisons with chemoimmunotherapy (CIT). The pooled incidence of summed cardiovascular events was 18.0% (95% CI 12.8-23.9). Compared with CIT, IV-based therapy was associated with higher risk of these events (RR 3.61, 95% CI 2.32-5.62), as well as atrial fibrillation and hypertension.
Key findings
- Grade ≥ 3 summed cardiovascular events occurred in 6.6% (95% CI 4.6-8.8) of patients receiving IV-based therapy.
- Atrial fibrillation/flutter occurred in 10.8% (95% CI 8.6-13.3); grade ≥ 3 events occurred in 3.6% (95% CI 2.6-4.9).
- Compared with CIT, IV-based therapy was associated with higher risks of atrial fibrillation (RR 5.50, 95% CI 2.68-10.10) and hypertension (RR 3.73, 95% CI 2.14-6.50).
- Ventricular arrhythmias/cardiac arrest and cardiac mortality were uncommon, occurring in 0.78% and 0.89% of patients, respectively.
Why it matters
The findings quantify cardiac events associated with a fixed-duration first-line regimen and indicate that atrial fibrillation and hypertension contribute substantially to its cardiovascular safety profile. These risks are relevant when weighing treatment options and planning cardiovascular assessment, while the low reported rates of ventricular arrhythmias and cardiac mortality provide important context.
What to keep in mind
The pooled incidence analysis combined prospective studies, while comparative estimates came from four randomized trials; the abstract does not report further limitations or details of follow-up.