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EHA 2026 | Managing cardiovascular toxicity with first-line BTK inhibitors in CLL
Florian Simon, MD, University Hospital Cologne, Cologne, Germany, discusses the cardiovascular toxicities associated with contemporary first-line chronic lymphocytic leukemia (CLL) treatments, particularly BTK inhibitors. He highlights the importance of recognizing and managing cardiovascular risks, selecting appropriate therapies, and working closely with cardiologists to optimize care for patients with comorbidities. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
This is a real important issue. So, first of all, we know that one of our main pillars of CLL therapy, continuous BTK inhibition, was associated or is associated with a profound impact on cardiovascular health, not only due to, well, basically new onset hypertension, new onset atrial fibrillation, but also complication of the treatment of these new diseases, so to speak, with regards to coagulation...
This is a real important issue. So, first of all, we know that one of our main pillars of CLL therapy, continuous BTK inhibition, was associated or is associated with a profound impact on cardiovascular health, not only due to, well, basically new onset hypertension, new onset atrial fibrillation, but also complication of the treatment of these new diseases, so to speak, with regards to coagulation. So we knew there was some sort of interaction with these agents. But as newer agents emerge and as we continue to learn from this experience, I think the scary part of that somewhat loses its impact. We know how to deal with these. We know what to expect in some patients and then we can make an informed decision. Obviously, we also have other agents, time-limited treatments with venetoclax-based therapy where we are less – scared is not really the right term – but where we should expect less cardiovascular toxicity. But then again, we have a patient cohort of comorbid patients to begin with. These are in median 72-year-old patients. So I think what also shines through more and more is that we basically need to work together with cardiologists or cardio-oncologists to really help guide treatment for these patients, not only with agent-specific toxicities, but also to not ignore maybe some cardiac comorbidities that these patients bring to the table with them to begin with.
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