Utility of the baseline cardiac imaging in the treatment decision for young patients with acute leukemia.

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e18005 Background: Anthracyclines, the backbone of acute leukemia induction regimens, are associated with risk of cardiotoxicity. Routine cardiac imaging is routinely performed before induction treatment with anthracycline based regimens (ABR).There is no standard guideline on the optimal method of LVEF assessment, nor consensus for the treatment implication of a borderline LVEF finding. The NCCN recommends cardiac imaging for patients with prior heart disease, prior anthracycline use, or clinical symptoms of cardiac dysfunction. We examine the role of routine pre-induction cardiac imaging in young adults diagnosed with acute leukemia. Methods: A database search at the University of Virginia identified patients newly diagnosed with ALL and AML (including APML), between the ages of 18 and 49 from 2000 to 2011. Baseline demographics, pre-treatment cardiac imaging, and the induction chemotherapy regimen chosen were abstracted. Results: A total of 71 patients with ALL or AML were identified. Thirty-three patients (46.5%) were female, and the average age was 36.1 (SD=9.9 years, range 18 to 49 ). Median baseline LVEF was 62.5 (range 54-74). Out of 71 patients, 25 had a borderline LVEF between 50% and 60%.The lowest baseline EF was 54%. Among 25 patients with borderline LVEF, all received ABR for induction. Conclusions: In patients under age 50 with newly diagnosed acute leukemias, pre-treatment cardiac imaging did not alter standard induction therapy with ABR. This suggests that induction therapy should not be delayed to await baseline LVEF assessment. A potential cost saving may be achieved in this population. Routine cardiac imaging may be more helpful in older adults or patients with prior cardiac history or anticipated need for consolidation with an ABR (ie APML).