Scoring System for the Risk of Heart Problems in CLL Patients Treated with Ibrutinib: An Italian Model

[Jm954]

An Italian scoring system worked better than 2 other risk models for predicting which patients with chronic lymphocytic leukemia (CLL) patients who were administered ibrutinib would later develop potentially life-threatening heart rhythms.

The finding, based on a retrospective study of 298 patients with CLL, may help clinicians distinguish between normal risk of atrial fibrillation (AFib) due to aging and the additive risk posed by this widely used drug.

“The important thing is that doctors already have this information in patients’ medical records, so it doesn’t require further testing to plug in numbers and come up with a score,” said William Archibald, MD, the study’s principal investigator and a resident internist at the Mayo Clinic in Rochester, Minnesota. Those scoring highest on the Italian model had an almost 50% risk of later developing AFib, he said, which may allow doctors to start planning ahead — choosing a different therapy to manage these chronic blood cancers or even stopping ibrutinib altogether.

The mechanism is poorly understood by which ibrutinib causes these erratic heart rhythms that damage the heart, or other heart problems, such as hypertension, he and others said. A more pressing concern, they suggested, is the excessive bleeding that can occur once AFib emerges.

Those considered at highest risk for these heart events might even be encouraged to wear an Apple Watch or some other monitoring device to track AFib, he said. “I hadn’t thought of it before, but it’s a great idea”

More here: cancertherapyadvisor.com/ho...

Jackie

[TimHB]

Very interesting. I was hospitalized with AFib after 6 months on ibrutinib. My CLL doc coordinated closely with my cardiologist on treatment and meds but I'm back to full dose of ibrutinib and I monitor my heart rate with a Fitbit. But I have a long history of hypertension and a staff hem-onc doing rounds when I was at the hospital took one look at my chart and said I NEVER should have been a candidate for ibrutinib given my heart history. Made me wonder what should have been done differently.

[Jm954 Administrator in reply to TimHB]

When I developed HT on Ibrutinib 3+ years ago my Dr said it was probably because I was stressed and not the treatment. Even then it wasn't considered a regular side effect as it is now.

Hindsight is a wonderful thing and, apart from the AFib ( ), it sounds as though Ibrutinib has been good for you Tim.

Jackie

[Benlewis]

What is the Italian model?

[Jm954 Administrator in reply to Benlewis]

It doesn't specify what is in the Italian model but they evaluated three clinical prediction models — the Framingham, Italian and Shanafelt risk scores.

The Italian risk score uses Akaike information criteria which is an estimator of the relative quality of statistical models for a given set of data. Given a collection of models for the data, AIC estimates the quality of each model, relative to each of the other models.

I didn't know this, I just looked it up and crikey, it looks complicated!

Here's a reference: sciencedirect.com/topics/me...

Jackie

[LovecuresCLL]

There is acalabrutinib and zanubrutinib. I wonder if these side effects will be lessened and these others meds will work as well? Nobody on this site is saying.

[Jm954 Administrator in reply to LovecuresCLL]

Not sure anyone knows yet, data too immature.

Jackie