Minimizing cardiac toxicity in children with acute myeloid leukemia.

TitleMinimizing cardiac toxicity in children with acute myeloid leukemia.
Publication TypeJournal Article
Year of Publication2021
AuthorsNarayan HK, Getz KD, Leger KJ
JournalHematology Am Soc Hematol Educ Program
Volume2021
Issue1
Pagination368-375
Date Published2021 12 10
ISSN1520-4383
Abstract

Anthracycline chemotherapy remains an integral component of modern pediatric acute myeloid leukemia (AML) regimens and is often delivered at high doses to maximize cancer survival. Unfortunately, high-dose anthracyclines are associated with a significant risk of cardiotoxicity, which may result in early and/or long-term left ventricular systolic dysfunction and heart failure. Moreover, the development of cardiotoxicity during pediatric AML therapy is associated with lower event-free and overall survival, which may be partially attributable to incomplete anthracycline delivery. A combined strategy of primary cardioprotection and close cardiac monitoring can maximize chemotherapy delivery while reducing the toxicity of intensive AML therapy. Primary cardioprotection using dexrazoxane reduces short-term cardiotoxicity without compromising cancer survival. Liposomal anthracycline formulations, which are under active investigation, have the potential to mitigate cardiotoxicity while also improving antitumor efficacy. Primary cardioprotective strategies may reduce but not eliminate the risk of cardiotoxicity; therefore, close cardiac monitoring is also needed. Standard cardiac monitoring consists of serial echocardiographic assessments for left ventricular ejection fraction decline. Global longitudinal strain has prognostic utility in cancer therapy-related cardiotoxicity and may be used as an adjunct assessment. Additional cardioprotective measures should be considered in response to significant cardiotoxicity; these include cardiac remodeling medications to support cardiac recovery and anthracycline dose interruption and/or regimen modifications. However, the withholding of anthracyclines should be limited to avoid compromising cancer survival. A careful approach to cardioprotection during AML therapy is critical to maximize the efficacy of leukemia treatment while minimizing the short- and long-term risks of cardiotoxicity.

DOI10.1182/hematology.2021000268
Alternate JournalHematology Am Soc Hematol Educ Program
PubMed ID34889355
Grant ListP30 CA023100 / CA / NCI NIH HHS / United States
K01 HL143153 / HL / NHLBI NIH HHS / United States