Early cardiac outcomes following contemporary treatment for childhood acute myeloid leukemia: A north American perspective12. Issue 9 (25th February 2013)

• Record Type: Journal Article
• Authors: Orgel, Etan; Zung, Laura; Ji, Lingyun; Finklestein, Jerry; Feusner, James; Freyer, David R.
• Is Part Of: Pediatric blood & cancer. Volume 60:Issue 9(2013:Sep.)
• Page Start: 1528
• Page End: 1533
• Publication Date: 2013-02-25
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.24498
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="pbc24498-sec-0001" sec-type="section"> <title>Background</title> <p>Anthracycline agents are used for treatment of acute myeloid leukemia (AML) but may cause late‐onset cardiomyopathy. Current frontline therapy for AML in North America, as reflected in the approach of the Children's Oncology Group (COG) and other pediatric consortia, is adapted from the anthracyline‐intensive Medical Research Council (MRC) regimen. The purpose of this study was to describe early post‐treatment cardiac function as a potential indicator of acute and long‐term risk associated with this approach.</p> </sec> <sec id="pbc24498-sec-0002" sec-type="section"> <title>Procedure</title> <p>A multi‐center retrospective cohort analysis was conducted of AML survivors diagnosed from 2004 to 2009 and treated with MRC‐based regimens. Change in left ventricular shortening fraction (LVSF) on echocardiogram was determined from baseline to latest post‐treatment/pre‐relapse value; associations with potential predictors were examined.</p> </sec> <sec id="pbc24498-sec-0003" sec-type="section"> <title>Results</title> <p>This cohort of pediatric survivors (n = 52) was assessed at a median interval of 13 months from end of treatment. Mean cumulative anthracycline dose was 339 ± 14 mg/m<sup>2</sup>. Mean baseline and post‐treatment LVSF were 39.3 ± 0.8% and 35.4 ± 0.9%, respectively; mean percent change for individuals was −8.4 ± 2.8% (<italic>P</italic> < 0.001). Cardiac‐directed medications were initiated in four patients (7.7%). Decline in LVSF was significantly associated with cumulative anthracycline dose, increasing BMI and Hispanic ethnicity.</p> </sec> <sec id="pbc24498-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Early, significant decline in LVSF was observed following treatment with these MRC‐based regimens. Elevated BMI and Hispanic ethnicity were identified as new independent risk factors. Children and adolescents so treated are at substantial risk for late‐onset cardiomyopathy, require monitoring with annual echocardiogram per current COG survivorship guidelines, and are good candidates for appropriate cardioprotection strategies. Pediatr Blood Cancer 2013;160:1528–1533. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>