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

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Centre Méditerranéen Hospitalo-Universitaire de Cardio-Oncologie

​Hôpital Nord, chemin des Bourrely, 13015 Marseille, France

Aix-Marseille Université

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© 2020 by Franck Thuny