Bcr-Abl inhibitors
(e.g., imatinib, dasatinib, bosutinib, nilotinib, ponatinib)
imatinib, bosutinib, dasatinib**
High or very high CV risk***
no
yes
ponatinib
nilotinib
Clinical examination by the hematologist AND ECG (QTc)
before cancer treatment begins
Cardio-oncological evaluation*
before the cancer treatment begins
Normal
CV symptoms OR ECG abnormality
Monitoring by the hematolgist
Cardio-oncological evaluation*AND PAD screening by ankle brachial index measurement and Doppler of carotid/lower extremity arteries
before the cancer treatment begins
Cardio-oncology evaluation* AND home blood pressure monitoring
every 3 months for 1 year, then every 6 months during
the Bcr-Abli therapy
PAD screening by ankle brachial index measurement and Doppler of carotid/lower extremity arteries
every 6 months if high or very high CV risk and yearly if intermediate risk
* A cardio-oncological evaluation will systematically include at least one visit with blood pressure, blood glucose, lipid profile, GFR calculation, ECG and trans-thoracic echocardiography (TTE). Measurements of global longitudinal strain and 3D LVEF (if feasible) are recommended with the same machine.
**TTE is recommended for baseline pulmonary pressure assessment.
*** Estimated by the current guidelines
CV=cardiovascular; PAD=peripheral artery disease; TTE=transthoracic echocardiogram