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Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper

Abstract: The incidence of acute myeloid leukemia (AML) increases with age. Intensive induction chemotherapy containing cytarabine and an anthracycline has been part of the upfront and salvage treatment of AML for decades. Anthracyclines are associated with a significant risk of cardiotoxicity (espe...

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Main Authors: Neuendorff, Nina Rosa (Author) , Loh, Kah Poh (Author) , Mims, Alice S. (Author) , Christofyllakis, Konstantinos (Author) , Soo, Wee-Kheng (Author) , Bölükbasi, Bediha (Author) , Oñoro-Algar, Carlos (Author) , Hundley, William G. (Author) , Klepin, Heidi D. (Author)
Format: Article (Journal)
Language:English
Published: February 25, 2020
In: Blood advances
Year: 2020, Volume: 4, Issue: 4, Pages: 762-775
ISSN:2473-9537
DOI:10.1182/bloodadvances.2019000955
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1182/bloodadvances.2019000955
Verlag, kostenfrei, Volltext: https://ashpublications.org/bloodadvances/article/4/4/762/452554/Anthracycline-related-cardiotoxicity-in-older
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Author Notes:Nina Rosa Neuendorff, Kah Poh Loh, Alice S. Mims, Konstantinos Christofyllakis, Wee-Kheng Soo, Bediha Bölükbasi, Carlos Oñoro-Algar, William G. Hundley, and Heidi D. Klepin
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Summary:Abstract: The incidence of acute myeloid leukemia (AML) increases with age. Intensive induction chemotherapy containing cytarabine and an anthracycline has been part of the upfront and salvage treatment of AML for decades. Anthracyclines are associated with a significant risk of cardiotoxicity (especially anthracycline-related left ventricular dysfunction [ARLVD]). In the older adult population, the higher prevalence of cardiac comorbidities and risk factors may further increase the risk of ARLVD. In this article of the Young International Society of Geriatric Oncology group, we review the prevalence of ARLVD in patients with AML and factors predisposing to ARLVD, focusing on older adults when possible. In addition, we review the assessment of cardiac function and management of ARLVD during and after treatment. It is worth noting that only a minority of clinical trials focus on alternative treatment strategies in patients with mildly declined left ventricular ejection fraction or at a high risk for ARLVD. The limited evidence for preventive strategies to ameliorate ARLVD and alternative strategies to anthracycline use in the setting of cardiac comorbidities are discussed. Based on extrapolation of findings from younger adults and nonrandomized trials, we recommend a comprehensive baseline evaluation of cardiac function by imaging, cardiac risk factors, and symptoms to risk stratify for ARLVD. Anthracyclines remain an appropriate choice for induction although careful risk-stratification based on cardiac disease, risk factors, and predicted chemotherapy-response are warranted. In case of declined left ventricular ejection fraction, alternative strategies should be considered.
Item Description:Gesehen am 30.03.2020
Physical Description:Online Resource
ISSN:2473-9537
DOI:10.1182/bloodadvances.2019000955

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