Mort Meredith K, Sen Jeremy M, Morris Amy L, DeGregory Kathlene A, McLoughlin Erin M, Mort Joseph F, Dunn Steven P, Abuannadi Mohammad, Keng Michael K
Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA, USA.
Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, USA.
J Oncol Pharm Pract. 2020 Apr;26(3):680-687. doi: 10.1177/1078155219873014. Epub 2019 Sep 9.
Acute myeloid leukemia patients receive anthracycline-containing induction chemotherapy. Anthracyclines cause cardiotoxicity; however, there is a paucity of data reflecting the risk of cardiotoxicity in the acute myeloid leukemia population, and risk factors for development of reduced left ventricular ejection fraction are not well established in this population.
A retrospective cohort study of adult acute myeloid leukemia patients receiving anthracycline-containing induction chemotherapy between March 2011 and August 2017 was performed. Baseline and all additional cardiac monitoring within one year of induction were collected. Home medications and new medication initiation were determined via the electronic health record and new outpatient prescriptions.
Of 97 evaluable patients, 25 (25.8%) developed reduced left ventricular ejection fraction and 18 (18.6%) experienced clinical heart failure within one year of induction. The median difference from baseline to lowest left ventricular ejection fraction was -5.0 percentage points, with a range of +10.0 to -52.5. The median time to onset of reduced left ventricular ejection fraction was 27 days, at a median cumulative anthracycline dose of 270 mg/m. No patient-specific or medication-specific factors were significantly associated with the risk of developing reduced left ventricular ejection fraction. Of 14 patients started on medical management for reduced left ventricular ejection fraction, 10 (71%) responded to therapy.
In this retrospective analysis, we observed that acute myeloid leukemia patients experienced reduced left ventricular ejection fraction more quickly and at lower doses than previously reported in the solid tumor population. Reduced left ventricular ejection fraction was at least partially reversible in most patients started on medical management. Although no factors were significantly associated with decreased cardiomyopathy risk, future assessment of cardioprotective medications may be warranted.
急性髓系白血病患者接受含蒽环类药物的诱导化疗。蒽环类药物会导致心脏毒性；然而，反映急性髓系白血病患者心脏毒性风险的数据较少，且该人群中左心室射血分数降低的危险因素尚未明确。
对2011年3月至2017年8月期间接受含蒽环类药物诱导化疗的成年急性髓系白血病患者进行回顾性队列研究。收集诱导治疗一年内的基线及所有其他心脏监测数据。通过电子健康记录和新的门诊处方确定家庭用药和新开始使用的药物。
在97例可评估患者中，25例（25.8%）在诱导治疗一年内出现左心室射血分数降低，18例（18.6%）发生临床心力衰竭。从基线到最低左心室射血分数的中位数差异为-5.0个百分点，范围为+10.0至-52.5。左心室射血分数降低的中位发病时间为27天，中位累积蒽环类药物剂量为270mg/m。没有患者特异性或药物特异性因素与左心室射血分数降低的风险显著相关。在14例因左心室射血分数降低而开始接受药物治疗的患者中，10例（71%）对治疗有反应。
在这项回顾性分析中，我们观察到急性髓系白血病患者左心室射血分数降低的速度比实体瘤患者更快，且剂量更低。大多数开始接受药物治疗的患者左心室射血分数降低至少部分可逆。尽管没有因素与心肌病风险降低显著相关，但未来可能有必要对心脏保护药物进行评估。
