Cardiovascular Complications After Chemotherapy and Targeted Agents

Several classes of medications used for the treatment of malignant hematological disorders are associated with cardiovascular complications. Anthracyclines used in treatment of leukemia mediate myocardial damage in a dose-dependent manner leading to heart failure at high cumulative doses. Anthracycline-induced cardiotoxicity is defined as LVEF decrease by >10% points, with a final value <53%. Patients with a history or symptoms of cardiac disease and prior exposure to cardiotoxic drugs or thoracic radiation, or those of an older age, should have an echocardiogram completed in pretreatment workup and consideration between cycles of regimens with high cumulative doses of anthracyclines. Many treating facilities include baseline echocardiogram for all patients planned to receive anthracyclines. Tyrosine kinase inhibitor (TKI) medications have multikinase targets and make up a heterogenous group of drugs, some of which result in arrhythmias, including hypertension, QT prolongation, and atrial fibrillation. For CML patients with CV risk factor of arterial vascular disease, providers should avoid ponatinib and agents with more QT prolongation, like nilotinib.