Anthracycline-Induced Cardiotoxicity in Acute Myeloid Leukemia Patients Who Undergo Allogeneic Hematopoietic Stem Cell Transplantation

There is paucity of data regarding the cardiotoxic effects of anthracycline treatment in the context of acute myeloid leukemia (AML) patients who undergo allogeneic hematopoietic stem cell transplantation (HSCT). Even a transient decrease in cardiac function might affect transplantation outcome. We reviewed the clinical records and echocardiography examinations of 78 patients with AML who received induction therapy and underwent HSCT. Twenty-two patients (28%) received daunorubicin at a dose of 90 mg/m2 per day and 53 patients (68%) received 60 mg/m2 per day or an equivalent dose of idarubicin. In 14 patients (18%) the postinduction ejection fraction declined by at least 10%. This change was temporary in 6 patients and longstanding in the remainder. Patients who developed systolic dysfunction had inferior overall survival (13 months compared with 27 months; P = .013). Patients whose diastolic function deteriorated had improved survival outcome (38 months compared with 17 months; P = .048). Although even transient reduction in systolic function might compromise survival outcome, diastolic dysfunction predicts improved survival in patients with AML who undergo HSCT. Impairment of cardiac function adversely affects the outcome of hematopoietic stem cell transplantation (HSCT). Therefore, we studied the acute cardiotoxic potential of anthracycline-containing induction regimens in 78 patients with acute myeloid leukemia who underwent HSCT. Fourteen patients (18%) developed dose-dependent systolic dysfunction, and deterioration of systolic function was associated with inferior survival outcome.