Evaluating the heart side effects of anthracycline treatment in patients with AML undergoing stem cell transplantation

This study evaluated the side effects associated with anthracycline treatment in patients with acute myeloid leukemia (AML) who undergo stem cell transplantation (SCT). This study concluded that anthracycline treatment may impact survival outcomes for these patients after a SCT.

Cytarabine (Ara-C) plus an anthracycline remains the standard first-line treatment for AML. Anthracyclines like doxorubicin (Adriamycin) play a major role in modern cancer treatment. Unfortunately, this type of anti-cancer drug is associated with side effects that affect the heart. These side effects may impact outcomes for patients who undergo a stem cell transplant (SCT).

Whether anthracyclines given before SCT lead to more side effects that affect the heart is unknown. 

This study included 78 patients with AML who had a SCT. Patients were treated with chemotherapy containing anthracyclines. 68% of patients had cardiovascular risk factors. These included smoking, heart disease, diabetes, and high cholesterol levels in the blood.

After treatment, 53% of patients developed mild diastolic dysfunction. This means that the heart’s ventricles become stiff. This results in the heart not filling up with blood properly. This can cause shortness of breath and irregular heartbeat. After 1 year of treatment, in 28% of patients, the diastolic function got worse.

1 year later, 18% of patients had the ejection fraction in their heart decrease by 10%. This means that the heart pumped out 10% less blood per heartbeat. This is called systolic dysfunction. This means that the heart cannot pump with enough force to push enough blood into circulation. This outcome was temporary in 43% of patients.

Patients who developed systolic dysfunction had significantly lower survival compared to patients who did not develop this condition (13 months vs. 27 months). However, patients with worse diastolic dysfunction had better survival compared to those with preserved diastolic function (38 months vs. 17 months).

This study concluded that anthracycline treatment may impact survival for patients with AML who undergo a stem cell transplant and develop systolic dysfunction.

This study had a small number of patients. Also, this study was retrospective, meaning it looked back in time to analyze data. More studies are needed to confirm these results.