Nilotinib treatment‐associated peripheral artery disease and sudden death: Yet another reason to stick to imatinib as front‐line therapy for chronic myelogenous leukemia

Abstract

Aichberger and colleagues recently described an association between nilotinib therapy for chronic myelogenous leukemia (CML) and adverse vascular events, which occurred in eight (~33%) of their 24 CML patients treated with nilotinib: severe peripheral artery disease (PAD; n = 3), less severe PAD (n = 1), sudden death (n = 1), myocardial infarction (n = 1), spinal infarction (n = 1), and subdural hematoma (n = 1) [1]. We were intrigued by these observations because of similar events that occurred in two of our patients receiving nilotinib therapy. A female patient developed severe and unrelenting PAD and coronary artery disease (CAD) after ~3 years of treatment with nilotinib and the second patient died suddenly after receiving nilotinib therapy for 3 weeks. None of the two patients had history of cardiovascular disease, tobacco use, or diabetes mellitus. These observations are troubling and question the prudence of rushing to replace imatinib with nilotinib, for front-line therapy in CML.