Heart Failure Rare for Imatinib, Leukemia 

CancerWise - October 2007

Congestive heart failure rarely occurs among survivors of leukemia who take imatinib (Gleevec®), according to a medical history review of 1,276 patients published Aug. 15 in the journal Blood.

Significance of results

“This study shows that there is no current need for routine cardiac-specific monitoring of all patients taking imatinib," says Jorge Cortes, M.D., senior author of the report and professor in M. D. Anderson’s Department of Leukemia. "However, those with cardiac history need to be closely monitored. Patients who develop symptoms of heart failure should be evaluated carefully and treated with standard therapy.”

Research methods

Scientists reviewed the medical histories of 1,276 patients who received imatinib on clinical trials at M. D. Anderson from July 28, 1998, to July 27, 2006.

The records belonged to patients treated for myeloproliferative (bone marrow) disorders and hematologic (blood) cancers, including acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and chronic myelogenous leukemia (CML).

Primary results

Researchers found that of the 1,276 patients, 22 (1.7%) had symptoms that could have been caused by heart failure.

Among them, 18 had conditions that are known to increase the risk of developing heart failure such as:

• Type II diabetes
• Hypertension
• Irregular heartbeat
• Coronary artery disease
• Congestive heart failure

Of the 22 patients found to have cardiovascular conditions, 11 were able to continue on imatinib for their leukemia after dose adjustments and management of the heart failure symptoms.

The standard of care for cardiac patients includes the use of beta blockers and angiotensin receptor blockers, notes study co-author Jean-Bernard Durand, M.D., an assistant professor in M. D. Anderson’s Department of Cardiology.

Additional results

The team also found the incidence of congestive heart failure among patients receiving imatinib to be comparable to the general population as reported by the Framingham Heart Study, a defining long-term study of cardiovascular disease in the United States.

Background

In a separate paper, published late last year, a research team led by scientists at the University of Pennsylvania reported that imatinib may be cardiotoxic in mammals.

Ten patients who developed congestive heart failure after exposure to imatinib were described in the paper. The paper did not assess the frequency of heart failure among patients taking imatinib or the potential risk factors involved.

Imatinib is approved by the U.S. Food and Drug Administration for the treatment of CML, Philadelphia-chromosome positive acute lymphoblastic leukemia (ALL) and gastrointestinal stromal tumor (GIST), a rare solid tumor cancer.

Before the drug was developed, only about half of CML patients survived five years after diagnosis. The five-year survival rate of patients taking imatinib is 95%.

What's next?

Research continues on the effects of imatinib on cardiovascular risk.

M. D. Anderson cardiologists also are working to develop a blood test to determine the risk of heart failure in patients about to undergo chemotherapy. However, the test also may help determine the cardiovascular risks if a patient were to take a certain drug such as imatinib, Durand says.

"If the blood test shows an elevated protein, we may start a patient on therapies that might protect his heart. This also may give us the ability to tell who will develop heart failure from a certain agent."

– From staff reports

Resources:

• Heart health and cancer (M. D. Anderson)
• Department of Leukemia (M. D. Anderson)
• Department of Cardiology (M. D. Anderson)