Heart complications common during blood cancer drug therapy, real-world cohort finds

Patients treated with Bruton’s tyrosine kinase inhibitors (BTKi) for lymphoproliferative blood cancers experienced a substantial burden of cardiovascular complications in a new real-world cohort study, although permanent discontinuation of cancer therapy because of heart toxicity was uncommon. The findings, published in the journal Cardio-Oncology, come from a single tertiary centre that manages these patients through a dedicated, structured cardio-oncology programme.

BTK inhibitors have transformed the management of lymphoproliferative disorders, but they are consistently associated with cardiovascular toxicities that can compromise optimal oncological treatment. Evidence guiding structured cardiovascular management in this setting has remained limited, which motivated the research team to evaluate how often these complications occur, how they present, how they are diagnosed and how they are managed when patients are cared for within a standardised surveillance protocol.

The study was a single-centre retrospective cohort analysis of consecutive patients who initiated BTK inhibitor therapy at a tertiary centre. All patients were managed according to a standardised multidisciplinary cardio-oncology surveillance protocol implemented in routine clinical practice. The researchers specifically assessed cardiovascular complications during treatment, focusing on atrial fibrillation, hypertension and heart failure.

Among 114 patients, with a median BTK inhibitor treatment duration of 13 months (interquartile range 5 to 32 months), 44 patients, or 38.6 percent, developed at least one cardiovascular complication. Hypertension was the most frequent, affecting 24 patients (21.1 percent), followed by atrial fibrillation in 19 patients (16.7 percent) and heart failure in 12 patients (10.5 percent). The rate of first cardiovascular complications was 28.68 per 100 person-years, with a 95 percent confidence interval of 20.84 to 38.50.

In exploratory univariable Cox analyses, older age, baseline hypertension, left atrial dilatation and increased interventricular septal thickness were associated with specific cardiovascular complications. A separate pattern emerged for bleeding: older age, baseline hypertension and baseline anticoagulant therapy were associated with bleeding events. The authors emphasise that these analyses were exploratory and univariable, so they should be interpreted with appropriate caution.

An interesting generational signal appeared for atrial fibrillation. The rhythm disorder occurred less frequently among patients receiving second-generation BTK inhibitors compared with earlier agents, although the time to atrial fibrillation occurrence did not differ significantly between BTKi generations, with a log-rank p value of 0.072.

Despite the substantial burden of cardiovascular complications, the clinical consequences for cancer treatment were limited. Permanent BTK inhibitor discontinuation due to cardiovascular toxicity was uncommon, affecting just 3.5 percent of patients, and cardiovascular mortality was low at 2.6 percent.

The study’s authors conclude that in this high-risk real-world population, a substantial burden of atrial fibrillation, hypertension and heart failure was observed during BTK inhibitor therapy.

Subject of Research: Cardiovascular complications in patients receiving Bruton's tyrosine kinase inhibitors managed within a structured cardio-oncology programme

Article Title: Cardiovascular complications with Bruton’s tyrosine kinase inhibitors in a structured cardio-oncology programme: a real-world cohort study

Article References: Belarte-Tornero, L. C., Gimeno, E., Ble Gimeno, M., Martos, T., Flores Morán, S., Rodríguez González, C., Martínez, F., Vicente Elcano, M., Ferra Coll, C. M., Ruiz-Bustillo, S., García-García, C., & Farré, N. (2026). Cardiovascular complications with Bruton’s tyrosine kinase inhibitors in a structured cardio-oncology programme: a real-world cohort study. Cardio-Oncology. https://doi.org/10.1186/s40959-026-00578-9

Image Credits: AI Generated

DOI: 10.1186/s40959-026-00578-9

Keywords: BTK inhibitors, cardio-oncology, atrial fibrillation, hypertension, heart failure, cardiotoxicity, lymphoproliferative disorders, cohort study, drug safety, cardiovascular surveillance, Cardiovascular, complications