Dexrazoxane exposure and risk of secondary acute myeloid leukemia in pediatric oncology patients.

TitleDexrazoxane exposure and risk of secondary acute myeloid leukemia in pediatric oncology patients.
Publication TypeJournal Article
Year of Publication2015
AuthorsSeif AE, Walker DM, Li Y, Huang YS, Kavcic M, Torp K, Bagatell R, Fisher BT, Aplenc R
JournalPediatr Blood Cancer
Date Published04/2015
KeywordsAdolescent, Adult, Anthracyclines, Cardiotonic Agents, Cardiotoxins, Child, Child, Preschool, Databases, Factual, Dexrazoxane, Female, Follow-Up Studies, Humans, Infant, Leukemia, Myeloid, Acute, Male, Neoplasms, Second Primary, Retrospective Studies, Risk Factors, United States

BACKGROUND: Dexrazoxane may reduce anthracycline-associated cardiotoxicity in pediatric cancer patients. However, concerns of secondary acute myeloid leukemia (AML) have led to restrictions on pediatric dexrazoxane use in Europe. Published data about dexrazoxane-associated secondary AML are limited and conflicting. We sought to estimate the secondary AML risk in children receiving dexrazoxane after anthracycline exposure.

PROCEDURE: A retrospective cohort of children with newly identified malignancies (excluding AML) receiving anthracyclines between January 1, 1999 and March 31, 2011 was established using the Pediatric Health Information System (PHIS). Patients were followed for all subsequent admissions to identify dexrazoxane exposures and secondary AML, defined by AML ICD-9 codes and AML induction chemotherapy. Logistic regression was used to model the association of dexrazoxane and secondary AML risk. A propensity score was used to adjust for measurable confounding.

RESULTS: Of 15,532 patients in the cohort exposed to anthracyclines, 1,406 received dexrazoxane. The secondary AML rate was 0.21% (3 of 1,046) in dexrazoxane-exposed and 0.55% (77 of 14,126) in unexposed patients. In a propensity score-adjusted multivariate analysis, dexrazoxane exposure was not associated with an increased risk of secondary AML, OR = 0.38, 95% CI 0.11-1.26.

CONCLUSIONS: Dexrazoxane was not associated with an increased risk of secondary AML in a large cohort of pediatric cancer patients receiving anthracyclines in US hospitals. While these data support dexrazoxane's safety in the general pediatric oncology population, additional studies are needed to confirm these findings and to quantify dexrazoxane's long-term cardioprotective effects.

Alternate JournalPediatr Blood Cancer
PubMed ID24668949
PubMed Central IDPMC4177031
Grant List1 R01 CA3881-01 / CA / NCI NIH HHS / United States
R01 CA133881 / CA / NCI NIH HHS / United States
R01 CA165277 / CA / NCI NIH HHS / United States