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Heart Problems and Leukemia: Understanding the Connection

Posted on March 16, 2022
Medically reviewed by
Mark Levin, M.D.
Article written by
Maureen McNulty

Heart problems are a potential complication of leukemia — they are related conditions that may develop as a result of leukemia or its treatments. People with leukemia are more likely to develop cardiovascular conditions compared with the general population. Those who experience heart disease along with leukemia may need to adjust their treatment plans in order to keep both conditions under control.

Drugs called anthracyclines are often used to treat acute leukemias. They can lead to dose-dependent heart failure, a condition in which a person’s heart can’t pump blood to the body as well as is needed. One study of 450 people with acute leukemia found that 11.6 percent of those with acute myeloid leukemia (AML) and 3.4 percent of those with acute lymphoblastic leukemia (ALL) experienced heart failure. Children with these cancers may also have a higher risk as compared to adults. About 65 percent of people who received anthracycline drugs to treat childhood cancer have heart abnormalities.

People with chronic lymphocytic leukemia (CLL) may develop heart conditions as well. Over half of people with CLL treated with Imbruvica (ibrutinib) may develop atrial fibrillation (AFib). During AFib, the heart beats irregularly. AFib can lead to an increased risk of more serious cardiovascular problems. Ibrutinib also frequently leads to hypertension (high blood pressure). According to one study of nearly 250 patients taking the drug, up to 1 in 3 adults with CLL develop hypertension.

Researchers have also linked chronic myeloid leukemia (CML) treatments to heart problems. Targeted therapies used to treat CML can sometimes lead to pulmonary arterial hypertension (PAH). People with this condition have high blood pressure within the blood vessels of the lungs. One report looking at a group who used targeted therapies found PAH affected only 0.2 percent of its pool, while a separate study reported closer to 5 percent for its pool of participants.

Some members of MyLeukemiaTeam have reported struggling with heart problems after undergoing leukemia treatment. “Some side effects are really bad and really blindside you,” said one member. “Even though I can live with [leukemia], I also now have to deal with pulmonary arterial hypertension and congestive heart failure. It does not make you want to take these medications but the alternative is not so good either.” It is important to work with your health care team to weigh the risks and benefits of different cancer therapies in order to find the best solution specifically for you.

Causes and Risk Factors

Leukemia may lead to heart problems in different ways. Leukemia cells may create changes within the body that make it harder for the heart to function properly. Additionally, leukemia treatments can damage the heart.

Cardiovascular disease may also become more common in people with leukemia as cancer treatments get better. Treatments for leukemia have improved greatly, leading to better survival rates. As people with leukemia live increasingly longer, there is a possibility that health problems — including heart disease — may appear later in life.

How Leukemia Affects the Heart

A recent study found that acute leukemias may directly harm a person’s heart. In someone with ALL or AML, their heart can’t pump blood to the rest of the body as well as it needs to. Researchers saw this effect in people who hadn’t yet undergone treatment, which showed that leukemia itself causes these changes.

It’s not entirely clear how leukemia cells can affect the way the heart works. Cancer cells may spread to the heart and make it harder for the heart muscle to work properly. Leukemia can also cause anemia (low levels of red blood cells) and lead to blood clots that block the blood vessels, both of which can lead to heart failure.

Some studies have also found that gene changes may be involved. For example, some people with leukemia have mutations in their IDH1 or IDH2 genes. These mutations cause leukemia cells to produce an abnormal substance that can damage the heart.

Acute Leukemia Treatments and Heart Problems

Many people with ALL or AML receive anthracycline drugs. Unfortunately, these medications can damage the cells of the heart and may eventually cause heart failure. When heart failure develops, it most often occurs within one year after the start of treatment with anthracyclines.

To assess a person’s risk of heart problems while using anthracyclines, there are certain considerations:

  • Age — Adults over the age of 65 have a higher risk of heart failure.
  • Dosage — Higher doses of anthracyclines are more likely to cause damage than lower doses.
  • Sex — Females experience heart damage from these drugs more often than males.
  • Medical history — Having a history of hypertension or other cardiac disorders leads to an increased chance of heart problems while using anthracyclines.

There may be ways to reduce your risk of heart problems while taking leukemia treatments. Using lower doses of these medications can help. Additionally, other drugs like Totect (dexrazoxane) can help protect your heart while taking anthracyclines.

Heart Problems During Treatment for CLL

Ibrutinib is a targeted therapy drug that can help treat CLL. The drug blocks an enzyme called Bruton’s tyrosine kinase (BTK) that is present within CLL cells. In one study of nearly 300 people with CLL who used ibrutinib, 17 percent experienced atrial fibrillation. People who had a history of heart problems were more likely to experience the complication.

Ibrutinib can also increase your blood pressure. It can have this effect both for people who had normal blood pressure and for those who had hypertension before starting ibrutinib.

CML Treatments and Heart Conditions

People with CML usually take targeted therapies called tyrosine kinase inhibitors (TKIs). These drugs include:

  • Bosulif (bosutinib)
  • Gleevec (imatinib)
  • Sprycel (dasatinib)
  • Tasigna (nilotinib)

These drugs can all cause PAH. Sometimes, PAH doesn’t lead to any symptoms. In other cases, it can cause shortness of breath, fainting, or trouble performing physical activity.

Living With Leukemia and Heart Problems

It may be hard to tell when a new feeling or sensation is a heart problem or a cancer symptom. For example, both heart failure and anemia caused by leukemia can cause symptoms like tiredness and abdominal swelling. Leukemia alone, and its treatments, too, can also cause those same effects.

Many people living with leukemia experience a lot of stress and anxiety, which can lead to changes in heart rhythm or feelings of tightness in the chest. One member of MyLeukemiaTeam reported experiencing this. “When I feel stressed out or anxious my shoulders and neck get tight and I overthink every little feeling in my chest. I saw a cardiologist who said it’s not my heart. Anyone else get this too?” Another member responded, “Yes, but it seems to me to be a physical reaction to stress.”

Make sure to tell your doctor about any new health problems. Your doctor can help you understand whether a health problem is caused by leukemia, leukemia treatments, or heart problems. Some problems may be serious and require additional medical care.

Adjusting Leukemia Treatments

If you develop heart problems while undergoing leukemia treatment, you may need to work with your doctor to decide on a new leukemia treatment plan. People who take anthracyclines for ALL or AML may need to switch to a different chemotherapy drug if they experience heart-related side effects. When people with CLL develop heart problems from ibrutinib, they may be able to take a lower dose of this drug.

Many members of MyLeukemiaTeam have found that they needed to switch to a different therapy when they developed heart problems. One member reported having a bad experience with nilotinib: “It made me vomit all day long and have heart palpitations. I take Gleevec now.”

Another member had problems with dasatinib. “[Side effects] that kind of snuck up on me were shortness of breath, increase in blood pressure, and a pounding heartbeat. It ended up being fluid in my lungs and around my heart. It leads to congestive heart failure.” This member’s doctor ended up switching them to a different medication.

Heart conditions may also affect a person’s leukemia prognosis. The development of treatment-related cardiovascular problems can lead to shorter survival rates. One MyLeukemiaTeam member wrote that this was the case for their partner. “While recovering from a massive heart attack in the hospital, the doctors told my partner he has leukemia. … His heart is too damaged to withstand radiation and his heart won’t heal or ever work properly because of the leukemia.”

It may be helpful to see both a hematologist-oncologist (a doctor who specializes in blood disorders and cancer) and a cardiologist (a doctor who specializes in heart conditions). Both doctors may be able to work together to help come up with a treatment plan that is effective in controlling both conditions.

Managing Heart Problems

Treating your heart problems may help improve your quality of life and allow you to continue your leukemia treatments. Different cardiovascular conditions are treated in different ways.

When heart failure is caused by anthracyclines, it is treated in the same way as heart failure that developed from other causes. Treatments may include medications like ACE inhibitors, beta-blockers, and loop diuretics. Making lifestyle changes to help keep your heart healthy may also help. More advanced cases of heart failure may need to be treated with surgery.

Many people who use ibrutinib begin taking new medications that can help lower their blood pressure. If a person is already using these medications, their dose may need to be adjusted. Hypertension may go away over time, once leukemia treatment is complete.

Medication is also used to treat PAH. Switching to another TKI may also help, since each drug seems to affect people a little differently.

Certain habits can help you keep your heart as healthy as possible while you are undergoing treatment for leukemia. These include:

  • Eating foods that contain a lot of fiber
  • Avoiding foods that contain high levels of saturated fat, trans fat, or cholesterol
  • Eating less salt
  • Limiting how often you drink alcohol
  • Quitting smoking cigarettes
  • Exercising at least half an hour, five days per week
  • Maintaining a healthy weight

Talk With Others Who Understand

On MyLeukemiaTeam, the social network for people with leukemia and their loved ones, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Are you living with leukemia? Have you experienced any heart issues? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

References
  1. Complication — National Cancer Institute
  2. Symptomatic Heart Failure in Acute Leukemia Patients Treated With Anthracyclines — JAAC: CardioOncology
  3. Anthracycline Cardiotoxicity: Prevalence, Pathogenesis, and Treatment — Current Cardiology Reviews
  4. Atrial Fibrillation in Patients With Chronic Lymphocytic Leukemia (CLL) Treated With Ibrutinib: Risk Prediction, Management, and Clinical Outcomes — Annals of Hematology
  5. Atrial Fibrillation — Centers for Disease Control and Prevention
  6. Managing Hypertension in Patients Treated With Ibrutinib for Chronic Lymphocytic Leukemia — Memorial Sloan Kettering Cancer Center
  7. Pulmonary Arterial Hypertension — NORD
  8. Pulmonary Hypertension With Dasatinib and Other Tyrosine Kinase Inhibitors — Pulmonary Circulation
  9. Acute Leukemia Is Associated With Cardiac Dysfunction Before Chemotherapy — Circulation
  10. Acute Myeloid Leukaemia as a Cause of Acute Ischaemic Heart Disease — Netherlands Heart Journal
  11. Chemotherapy for Acute Lymphocytic Leukemia (ALL) — American Cancer Society
  12. Cardiovascular Side Effects of Cancer Therapies: A Position Statement from the Heart Failure Association of the European Society of Cardiology — European Journal of Heart Failure
  13. Targeted Therapy Drugs for Chronic Lymphocytic Leukemia — American Cancer Society
  14. Treating Chronic Myeloid Leukemia by Phase — American Cancer Society
  15. Comparative Analysis of Pulmonary Hypertension in Patients Treated With Imatinib, Nilotinib, and Dasatinib — British Journal of Haematology
  16. Heart Failure — Mayo Clinic
  17. Signs and Symptoms of Acute Lymphocytic Leukemia (ALL) — American Cancer Society
  18. Anxiety and Depression — Leukemia & Lymphoma Society
  19. Heart Failure (Congestive Heart Failure) — Cleveland Clinic
  20. High Incidence of Hypertension in Children Presenting With Acute Lymphoblastic Leukemia — Pediatric Hematology and Oncology
  21. Heart Disease — Centers for Disease Control and Prevention
  22. The Risk of Atrial Fibrillation With Ibrutinib Use: A Systematic Review and Meta-Analysis — Blood

All updates must be accompanied by text or a picture.
Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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