Dr. Mato from the University of Pennsylvania does important practical research in chronic lymphocytic leukemia (CLL) that makes a difference in how patients thrive. At the iwCLL 2017 meeting in Manhattan, he presented his findings on a common problem seen in chronic lymphocytic leukemia, atrial fibrillation or AF or AFib. AFib is an arrhythmia or irregular heart rhythm mostly seen in elderly patients, with or without CLL.
The American Heart Association has a nice animation on AFib here for those who want to learn more, but it is enough to understand that it occurs when the upper chambers or atrium of the heart don’t pump properly, leading to irregular heartbeats and increasing the risk of blood clots, stroke and heart failure.
The risk of a stroke is calculated using the patient’s CHAD2 score that can be calculated here. The score helps determine the proper choice of therapy. Remember CHAD2 scores only applies to those with AFib.
Because CLL is mostly a disease of the elderly, AFib is not an uncommon problem that needs to be managed. That management can involve blood thinners or aspirin that can significantly increase risks of a serious hemorrhage. When ibrutinib is used to treat the CLL that may also increases bleeding risk.
Dr. Mato’s research looked at the scope of these issues and how to best predict and manage potential problems.
Take Away Points:
- Ibrutinib increases the risk of developing AFib to about one in ten.
- AFib is the most common cause of ibrutinib interruption or discontinuation.
- Treatments for AFib might include aspirin or anticoagulants (blood thinners) such as Coumadin (warfarin) and others, and different medicines that control the heart rate and/or rhythm.
- Short-term complications in CLL patients in this study were rare from all the medicines used to treat AFib.
- All the patients studied who developed AFib were able to continue their ibrutinib.
- A simple inexpensive ECG that can be done in most doctors’ offices can help predict who is more likely to develop AFib.
- More research is needed to understand why ibrutinib increases the risk of AFib.
Here is the link to the iwCLL oral abstract from Lymphoma Hub.
Here is a link to my short audio interview with Dr. Mato from iwCLL 2017 or you can read the transcript here
This research again reinforces the advantages of being cared for by a team that specializes in CLL.
Brian Koffman, MD 8-22-17