title: Congestive heart failure during induction with anthracycline-based therapy in patients with acute promyelocytic leukemia.
abstract: BACKGROUND
  Acute promyelocytic leukemia (APL) is a highly curable malignancy. However, 30% of patients die during therapy induction from bleeding, differentiation syndrome (DS), and/or infection. Recommendations suggest that congestive heart failure (CHF) is a presenting feature of DS.
  
  
  OBJECTIVE
  To assess the incidence of CHF during induction in patients with APL.
  
  
  METHODS
  A retrospective chart review was performed of patients diagnosed with APL from December 2004 to July 2013 and managed at Georgia Regents University Cancer Center. Baseline and follow-up ejection fractions (EF) were recorded and patients with a drop in EF during the induction period were evaluated.
  
  
  RESULTS
  Of the 40 evaluable patients, 37 received idarubicin-based chemotherapy. 16 of the 37 patients had a repeat ECHO for suspected cardiomyopathy, and 6 of the 16 patients (37.5%) demonstrated a decrease in EF (absolute drop, 10%-35%). The cardiac function recovered completely in 4 patients and partially in 1 patient. Gender, history of hypertension, and body mass index did not seem to correlate with incidence of CHF.
  
  
  CONCLUSIONS
  The patient population is very small given the rarity of the disease. Present practice patterns do not routinely address CHF in the differential diagnosis.
  
  
  CONCLUSIONS
  Patients with APL are at risk for cardiac toxicity for a number of reasons, including cytokine storm and inflammatory state, use of anthracyclines, and DS. The clinical presentation of DS most commonly involves dyspnea and fluid retention, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out CHF in APL patients who are going to receive an anthracycline-based therapy, because early intervention may result in an improved outcome.
authors: Winship Cancer Institute, Emory University, Atlanta, Georgia, USA. vkota@emory.edu.
authors: Vamsi
authors: V
authors: Kota
authors: Georgia Regents University Cancer Center, Augusta, Georgia, USA; and University of Georgia College of Pharmacy, Athens, Georgia, USA.
authors: Amber
authors: A
authors: Clemmons
authors: Georgia Regents University Cancer Center, Augusta, Georgia, USA.
authors: Arati
authors: A
authors: Chand
authors: Georgia Regents University Cancer Center, Augusta, Georgia, USA.
authors: Josh
authors: J
authors: Simmons
authors: Department of Medicine, Georgia Regents University, Augusta, Georgia, USA.
authors: Joshua
authors: J
authors: Mansour
authors: Department of Pathology, Georgia Regents University, Augusta, Georgia, USA.
authors: Ravindra
authors: R
authors: Kolhe
authors: Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
authors: Anand
authors: A
authors: Jillella
keywords: acute promyelocytic leukemia; congestive heart failure; differentiation syndrome