SHM Converge Scientific Abstract ePoster Gallery-Ponatinib-Induced Congestive Heart Failure

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This case report describes a 36-year-old man with chronic myelogenous leukemia (CML) carrying the T315I mutation, a resistant mutation for which ponatinib is often the preferred treatment. Although he initially tolerated ponatinib, he later developed progressive fatigue, dyspnea on exertion, orthopnea, palpitations, and chest discomfort. He had no prior major cardiovascular risk factors or known heart disease before starting therapy.<br /><br />On presentation, testing showed elevated BNP, pulmonary vascular congestion on chest X-ray, and severe new cardiac dysfunction on echocardiogram, with left ventricular ejection fraction falling to 10% and marked global hypokinesis. Prior studies had already shown reduced function, suggesting progressive cardiomyopathy. Ponatinib was stopped because of its known association with cardiovascular toxicity, and the patient was started on guideline-directed heart failure therapy and diuretics.<br /><br />Despite treatment, his condition worsened, with recurrent hospitalizations for heart failure exacerbations. During this admission he suffered ventricular tachycardia/ventricular fibrillation arrest and required VA ECMO. Imaging later revealed extensive intracardiac and cannula-associated thrombus with absent cardiac contractility. Given the severe, terminal cardiomyopathy and poor prognosis, care was transitioned to comfort measures.<br /><br />The report highlights the importance of early recognition of ponatinib-related cardiotoxicity, careful cardiac monitoring in patients receiving BCR-ABL1 tyrosine kinase inhibitors, and prompt discontinuation of the drug when cardiac dysfunction emerges. It also underscores the need for better strategies to prevent and manage severe cardiovascular adverse effects in CML patients who require ponatinib.

Asset Subtitle

Aymen Baig

Meta Tag

Author List Aymen Baig, Christian Peña, Ting-Wei Lu

Category Clinical Vignettes

Concept Ponatinib

Concept Cardiotoxicity

Concept T315I Mutation

Concept Heart Failure

Concept Cardiomyopathy

Distinguished Non-Finalist

Presenter Organization UTHSCSA - UT Health Science Center at San Antonio

Presenting Author Aymen Baig

Track Adult

Keywords

chronic myelogenous leukemia

CML

T315I mutation

ponatinib

cardiotoxicity

cardiomyopathy

heart failure

left ventricular ejection fraction

ventricular tachycardia

VA ECMO

Ponatinib

Cardiotoxicity

T315I Mutation

Heart Failure

Cardiomyopathy