Cardiovascular Toxicities of BTK Inhibitors in Chronic Lymphocytic Leukemia

This review from a leading Cardiology journal outlines the current data surrounding key potential cardiotoxic adverse events that can be associated with BTK inhibitors in CLL, including ibrutinib, acalabrutinib, zanubrutinib, and pirtobrutinib, with a specific focus on atrial fibrillation, ventricular arrhythmias/sudden death, hypertension, heart failure, bleeding, and stroke. Importantly, the authors note that use of BTK inhibitors (BTKi) in CLL can be associated with a 3- to 5-fold increased risk of atrial fibrillation compared with those patients who have not received a BTKi. Furthermore, development of cardiovascular adverse effects while on a BTKi is associated with worse long-term cardiovascular and overall survival. The article also provides information about potential cardiovascular adverse events with venetoclax, another possible CLL treatment. Finally, the authors outline key strategies for management of cardiovascular AEs associated with CLL-directed therapy.