title: Early cardiac outcomes following contemporary treatment for childhood acute myeloid leukemia: a North American perspective.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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(2) . 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% (P < 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.
  
  
  CONCLUSIONS
  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.
authors: Jonathan Jaques Children's Cancer Center, Miller Children's Hospital, Long Beach, California, USA.
authors: Etan
authors: E
authors: Orgel
authors: Laura
authors: L
authors: Zung
authors: Lingyun
authors: L
authors: Ji
authors: Jerry
authors: J
authors: Finklestein
authors: James
authors: J
authors: Feusner
authors: David R
authors: DR
authors: Freyer
mesh_terms: D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000401:mortality / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D018943:Anthracyclines
keywords: AML; cardiotoxicity; late effects