Patients with Acute Leukemia Treated with Anthracyclines Have Increased Risk for Heart Failure

Patients with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) who are treated with anthracyclines have an elevated risk of heart failure, according to new research published in JACC Cardio-Oncology.

“While we are more effective at treating cancer, the improved survival rates have helped to unmask the cardiotoxic impact of some of the most common cancer therapies,” said the study author Marielle Scherrer-Crosbie, MD, PhD, director of the Cardiac Ultrasound Laboratory and a professor of Cardiovascular Medicine in the Perelman School of Medicine at the University of Pennsylvania, in a press release. “Our hope, in creating this risk score system, is to help clinicians identify patients with the highest risk for potential cardiac damage, so they can more closely monitor the patients via a multidisciplinary approach.”

Symptomatic Heart Failure in Acute Leukemia Patients Treated With Anthracyclines https://t.co/8y8CTW5vOn pic.twitter.com/C8LJpmbe66

— Rabi Hanna (@RabiHannaMD) December 18, 2019

The study included 450 patients with ALL or AML. About nine percent of these patients developed heart failure during the study an average of 10 months from exposure to treatment. Patients with AML tended to have a higher incidence of heart failure compared with patients with ALL. The authors then developed a risk score ranging from 0 to 21 based on clinical relevant variables and myocardial strain, assigning points to each variable: baseline global longitudinal strain >15% (6 points); baseline left ventricular ejection fraction <50%, pre-existing heart disease, and/or AML (4 points); cumulative anthracycline dose of 250 mg/m or more (2 points); and age over 60 (1 point). Patients were divided into groups based on risk scores: low (0 to 6), moderate (7 to 13) and high (14 to 21). Most patients were classified as low-risk. A total of 112 patients were classified as moderate risk and 20 were classified as high risk for heart failure. The authors reported that 65% of patients classified as high-risk developed heart failure. Just one percent of those in the low-risk group developed heart failure.

Will your patient with acute #leukemia started on treatment with anthracyclines develop #HF?

There is a risk score for that now.

Cohort of 450 patients, 40 of which had symptomatic #HF. Need larger study, but very interesting start. @JACCJournalshttps://t.co/31fbJ4vEyz pic.twitter.com/k6wKIgNg9q

— Amitabh C. Pandey (@AmitabhCPandey) December 18, 2019

“Additional studies are needed to determine the validity of these findings,” the researchers wrote in their abstract.

In an accompanying editorial, the authors praised the approach of skipping over soft definitions and moving in the direction of focusing on hard endpoints.

“The work by Kang et al. is a move in the right direction, with regard to studying anthracycline toxicity by using well-established and clinically relevant cardiovascular endpoints such as symptomatic heart failure,” they wrote.

Symptomatic Heart Failure in Acute Leukemia Patients Treated With Anthracyclines https://t.co/cDh5stsERk

— Katie (@KatieSDodd) December 18, 2019