Incidence and risk factors for development of cardiac toxicity in adult patients with newly diagnosed acute myeloid leukemia

Abstract

Abstract The incidence of cardiac morbi-mortality in acute myeloid leukemia (AML) is not well known. We aim to estimate the cumulative incidence (CI) of cardiac events in AML patients (pts) and to identify risk factors for their occurrence. Among 571 newly diagnosed AML pts, 26 (4.6%) developed fatal cardiac events and 19 (3.6%) among 525 treated pts (CI: 2% at 6 months; 6.7% at 9 years). Prior heart disease was associated with development of fatal cardiac events [Hazard Ratio (HR) = 1.9]. The CI of non-fatal cardiac events was 43.7% at 6 months and 56.9% at 9 years. Age ≥ 65 (HR = 2.2), relevant cardiac antecedents (HR = 1.4) and non-intensive chemotherapy (HR = 1.8) were associated with non-fatal cardiac events. The 9-years CI of grade 1–2 QTcF prolongation was 11.2%, grade 3 was 2.7%, and no patient had grade 4–5 event. The 9-years CI of grade 1–2 cardiac failure was 1.3%, grade 3–4 was 15%, and grade 5 2.1%; of grade 1–2 arrhythmia was 1.9%, grade 3–4 was 9.1%, and grade 5 1%. Among 285 intensive therapy pts, median overall survival decreased in those experiencing grade 3–4 cardiac events (p < 0.001). We observed a high incidence of cardiac toxicity associated with significant mortality in AML.