Prevalence and therapeutic relationships of pericardial effusions in patients with leukemia

Abstract

7067 Background: Little is known regarding the prevalence and natural history of pericardial disease in patients with leukemia. Recently, there have been reports of an increased incidence of pericardial effusions (PEf) in patients receiving histone deacetylase inhibitors (HDACi) such as MGCD0103. Although a direct causal relationship has not been established yet, this complication may have a significant impact for the future development of this class of drugs. To study this issue, we retrospectively analyzed a large cohort of patients with leukemia, who were evaluated at MD Anderson Cancer Center (MDACC), to determine the prevalence, timing, and characteristics of PEf in leukemia. Methods: We reviewed 3,327 patients with acute myeloid leukemia (AML, N = 1,809, 54%), acute lymphocytic leukemia (ALL, N = 494, 15%), or myelodysplastic syndrome (MDS, N =1,024, 31%), who were seen at MDACC from August 2003 to July 2008. Of this group, 1,982 patients (60%) had an echocardiogram at some point during their care at MDACC. Data regarding diagnosis, timing, effusion size, and prior therapy was collected in the 401 patients (20.2%) that had echocardiographic evidence of PEf. Results: The overall prevalence of PEf was 21.7%, 21.1%, and 19.9% (p = 0.72) in patients with AML, ALL, and MDS, respectively. In the 401 total patients with PEf, 22.8%, 25.0%, and 18.4% (p = 0.33) of these effusions were found before treatment in the three disease categories, respectively. The rest occurred after some form of chemotherapy, accounting for 77.2%, 75.0%, and 81.6% (p = 0.73) of the total PEf by disease, respectively. Most PEf were of minimal size (67%) overall. No differences in effusion characteristics, including severity, were observed among different types of therapies including HDACi. Conclusions: PEf are relatively common in patients with leukemia at initial presentation and are usually asymptomatic. Their incidence increases with therapy administration although it appears that this is not a process related to specific classes of treatment or type of leukemia. No significant financial relationships to disclose.