Congestive heart failure (CHF) in acute myeloid leukemia patients during induction.

Abstract

7105 Background: Leukemia induction treatment is associated with significant morbidity and mortality. Myocardial stunning may be a result of chemotherapy as well as cytokines released from lysis of tumor cells leading to drop in ejection fraction (EF). When CHF is associated with sepsis, it may result in increased mortality. We report the incidence of CHF in leukemia patients undergoing induction. Methods: We performed a retrospective chart review on patients diagnosed with AML including acute promyelocytic leukemia (APL), who received chemotherapy between December 1, 2004 and December 31, 2012 at Georgia Regents University. Baseline and follow up EFs were recorded by echocardiogram or nuclear medicine scan. We evaluated patients who had a drop in EF after the first or subsequent inductions. We excluded patients who had a delayed drop in EF. Results: 217 consecutive patients with AML with normal ejection fraction at diagnosis were evaluated. 18 patients (8.2%) demonstrated a decrease in EF. This included 14 patients with AML and 4 with APL. 15 patients received one cycle of induction, 2 received re-induction and 1 was treated for relapsed disease. 2 patients did not receive anthracyclines(ACs). Median age of patients with CHF was 57 years (range 29-75). The median drop in EF was 23% (10-45%). Median days from the start of treatment to the observed drop were 25 (5-109). 6 patients are alive with median survival of 175 days. Overall, 5 out of 18 patients recovered their cardiac function with a median survival in these patients of 1,173 days. In 13 patients without recovery in EF survival was only 71 days. Conclusions: Chemotherapy by itself and cytokines released from treatment may result in reversible drop in EF in some patients and a persistent drop in the others. Re-induction is essential in a significant proportion of patients and ACs are commonly used that puts them at an increased risk for CHF. We propose that repeat cardiac evaluation, especially in patients getting re-induced, is necessary for identifying patients with cardiac abnormalities to prevent further cardiac injury and increased mortality.