Addressing cardiovascular toxicities of Bruton tyrosine kinase inhibitors in chronic lymphocytic leukaemia: practical recommendations for haematologists in central and eastern Europe

Advances in understanding the biology of chronic lymphocytic leukaemia (CLL) translated into revolutionary treatments with improved survival outcomes. Consequently, the traditional chemoimmunotherapy courses shifted to targeted therapies, including inhibitors of the Bruton tyrosine kinase (BTKis). BTKis correlate with an increased risk over time of toxicities of the cardiovascular (CV) system, which require proper management. An expert meeting involving 14 haematology and cardiology opinion leaders from 5 Central Eastern European countries was held, aiming to find pragmatic approaches for haematologists to identify the CLL patients at CV risk before starting the BTKis therapy, and further recognize, manage and monitor de novo cardiotoxicities occurring under treatment. Geographical variations have been described, including availability of reimbursed BTKis, national registries, and presence of cardio-oncology units. The experts discussed controversies, unmet needs and potential solutions by exemplifying local challenges and best practices. Each patient requires a personalized strategy based on multiple factors, hence practical pathways to follow during the continuity of care in CLL patients requiring BTKis have been proposed. Rigorous evaluation of the CV risk, periodic assessments of cardiotoxicity during BTKis treatment and work in multidisciplinary teams are vital for managing CV complications without unnecessary interruptions of the CLL treatment.