EHA Library - The official digital education library of European Hematology Association (EHA)

EARLY APPEARANCE OF CARDIOTOXICITY, IN CHILDREN WITH HEMATOLOGICAL MALIGNANCIES (HM)
Author(s): ,
Kondylia Antoniadi
Affiliations:
Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital ,Athens,Grèce;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital ,Athens,Griechenland;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's
,
Charikleia Kelaidi
Affiliations:
Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital,Athens,Grèce;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital,Athens,Griechenland;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's H
,
Vasiliki Tzotzola
Affiliations:
Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital,Athens,Grèce;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital,Athens,Griechenland;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's H
,
Maria Ampatzidou
Affiliations:
Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital,Athens,Grèce;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital,Athens,Griechenland;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's H
,
Evangelos Karanasios
Affiliations:
Department of Cardiology,Aghia Sophia Children's Hospital ,Athens,Grèce;Department of Cardiology,Aghia Sophia Children's Hospital ,Athens,Griechenland;Department of Cardiology,Aghia Sophia Children's Hospital ,Athens,Grecia;Department of Cardiology,Aghia Sophia Children's Hospital ,Athens,Greece;Department of Cardiology,Aghia Sophia Children's Hospital ,Athens,Grecia;Department of Cardiology,Aghia
,
Maria Drakopoulou
Affiliations:
First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grèce;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Griechenland;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grecia;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Greece;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athe
,
Vassilios Papadakis
Affiliations:
Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital ,Athens,Grèce;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital ,Athens,Griechenland;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's
,
Petros Nihoyannopoulos
Affiliations:
First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grèce;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Griechenland;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grecia;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Greece;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athe
,
Dimitrios Tousoulis
Affiliations:
First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grèce;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Griechenland;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grecia;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Greece;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athe
,
Konstantinos Toutouzas
Affiliations:
First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grèce;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Griechenland;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Grecia;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athens,Greece;First Department of Cardiology,Hippokration Hospital,Athens,Greece,Athe
,
Nikolaos Thomaidis
Affiliations:
Department of Chemistry,National and Kapodistrian University of Athens,Athens,Grèce;Department of Chemistry,National and Kapodistrian University of Athens,Athens,Griechenland;Department of Chemistry,National and Kapodistrian University of Athens,Athens,Grecia;Department of Chemistry,National and Kapodistrian University of Athens,Athens,Greece;Department of Chemistry,National and Kapodistrian Unive
Sophia Polychronopoulou
Affiliations:
Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital ,Athens,Grèce;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's Hospital ,Athens,Griechenland;Department of Pediatric Hematology-Oncology,Aghia Sophia Children's Hospital,Athens,Greece ,Aghia Sophia Children's
(Abstract release date: 05/12/22) EHA Library. Antoniadi K. 06/10/22; 358557; P1700
Kondylia Antoniadi
Kondylia Antoniadi
Contributions
Abstract
Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P1700

Type: Poster presentation

Session title: Quality of life, palliative care, ethics and health economics

Background
Cardiotoxicity is the most serious non-hematological toxicity of cancer treatment and is defined as acute(<1 month) and  early onset(< 1year from the initiation of treatment).

Aims
Aim of the study is the prospective analysis of the acute and early onset cardiotoxicity and outcome of patients with HM.

Methods
Cardiotoxicity was defined by any combination of 1) reduction of the ejection fraction> 10% or at a value <50%) 2) electrophysiological dysfunction 3) other abnormal ultrasound, clinical or enzymatic findings. During the period 2018-2021, 47 patients with HM treated in our Department were studied, due to early cardiotoxicity. Patiens’ characteristics:30/47 boys, median age 8.0 years old (range 2.5-16), 25 with ALL, 7 with AML, 2 with CML and 13 with Lymphoma. All patients underwent a complete clinical, laboratory and imaging examination (ECG, echocardiogram) at diagnosis, prior each regimen and at the onset of signs of cardiotoxicity.

Results

At admission 44/47 patients had a free medical history and normal tests. Two patients (1 with Hodgkin’s lymphoma and 1 with AML) had an abnormal troponin value before starting chemotherapy, without further clinical manifestations. The third patient, 3.5 years old with ALL, had hypertrophic cardiomyopathy from birth due to inherited Noonan syndrome.

Thirteen patients (9/13 boys) showed cardiotoxicity, 2 after the first regimen of chemotherapy (acute form) and 11 within the 1st year after onset (subacute form). Acute cardiotoxicity occurred in two patients (1 with high-risk ALL, 1 with Burkitt Lymphoma) with a decrease in ejection fraction (EF <55%) along with bradycardia and abnormal ECG. Subacute form of cardiotoxicity occurred in 11/13 patients. 4 patients (1 with AML high-risk monosomy 7, 1 with Hodgkin's Lymphoma, 1 with ALL and 1 with T-Lymphoblastic Lymphoma) showed reduced in ejection fraction (<55%) and concomitant increase in troponin value (max 35.85 pg/ml). Two patients with ALL showed an increase in cardiac enzymes (max value 98.05 pg / ml) with concomitant ECG disturbance and normal echocardiographic study. Two high-risk AML patients (1 due to FLT3 positivity), presented with pericardial fluid and QTc prolongation, respectively. One intermediate risk AML patient developed abnormal ventricular contractions with normal echocardiogram and cardiac enzymes and was treated with propranolol. Two patients, one with Hodgkin' Lymphoma and one with Burkitt Lymphoma, developed chest pain with elevated troponin but with normal ECG and echocardiographic study. Forty five patients received anthracyclines in a total dose of anthracyclines <360mg / m2 and no-one was irradiated. All thirteen patients showed gradual recovery over a period of 1 week to 2 months after the event. 5 patients were treated with ACE inhibitor or b-blocker. All patients continued their chemotherapy in full doses (2/13 with minor delay). In one patient the total dose was reduced to 1/3.

Conclusion
The early results of our ongoing study, show that moderate or severe cardiotoxicity occurred in 30% of patients with hematologic malignancies within the first year of diagnosis and 10% of them needed pharmaceutical intervention. The degree and course of cardiotoxicity seem to differ significantly between our patients, suggesting that both the underlying genetic predisposition and the presence of various other risk factors contribute to the severity of its manifestation.

Keyword(s): Anthracycline, Children, Late effects, Toxicity

Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P1700

Type: Poster presentation

Session title: Quality of life, palliative care, ethics and health economics

Background
Cardiotoxicity is the most serious non-hematological toxicity of cancer treatment and is defined as acute(<1 month) and  early onset(< 1year from the initiation of treatment).

Aims
Aim of the study is the prospective analysis of the acute and early onset cardiotoxicity and outcome of patients with HM.

Methods
Cardiotoxicity was defined by any combination of 1) reduction of the ejection fraction> 10% or at a value <50%) 2) electrophysiological dysfunction 3) other abnormal ultrasound, clinical or enzymatic findings. During the period 2018-2021, 47 patients with HM treated in our Department were studied, due to early cardiotoxicity. Patiens’ characteristics:30/47 boys, median age 8.0 years old (range 2.5-16), 25 with ALL, 7 with AML, 2 with CML and 13 with Lymphoma. All patients underwent a complete clinical, laboratory and imaging examination (ECG, echocardiogram) at diagnosis, prior each regimen and at the onset of signs of cardiotoxicity.

Results

At admission 44/47 patients had a free medical history and normal tests. Two patients (1 with Hodgkin’s lymphoma and 1 with AML) had an abnormal troponin value before starting chemotherapy, without further clinical manifestations. The third patient, 3.5 years old with ALL, had hypertrophic cardiomyopathy from birth due to inherited Noonan syndrome.

Thirteen patients (9/13 boys) showed cardiotoxicity, 2 after the first regimen of chemotherapy (acute form) and 11 within the 1st year after onset (subacute form). Acute cardiotoxicity occurred in two patients (1 with high-risk ALL, 1 with Burkitt Lymphoma) with a decrease in ejection fraction (EF <55%) along with bradycardia and abnormal ECG. Subacute form of cardiotoxicity occurred in 11/13 patients. 4 patients (1 with AML high-risk monosomy 7, 1 with Hodgkin's Lymphoma, 1 with ALL and 1 with T-Lymphoblastic Lymphoma) showed reduced in ejection fraction (<55%) and concomitant increase in troponin value (max 35.85 pg/ml). Two patients with ALL showed an increase in cardiac enzymes (max value 98.05 pg / ml) with concomitant ECG disturbance and normal echocardiographic study. Two high-risk AML patients (1 due to FLT3 positivity), presented with pericardial fluid and QTc prolongation, respectively. One intermediate risk AML patient developed abnormal ventricular contractions with normal echocardiogram and cardiac enzymes and was treated with propranolol. Two patients, one with Hodgkin' Lymphoma and one with Burkitt Lymphoma, developed chest pain with elevated troponin but with normal ECG and echocardiographic study. Forty five patients received anthracyclines in a total dose of anthracyclines <360mg / m2 and no-one was irradiated. All thirteen patients showed gradual recovery over a period of 1 week to 2 months after the event. 5 patients were treated with ACE inhibitor or b-blocker. All patients continued their chemotherapy in full doses (2/13 with minor delay). In one patient the total dose was reduced to 1/3.

Conclusion
The early results of our ongoing study, show that moderate or severe cardiotoxicity occurred in 30% of patients with hematologic malignancies within the first year of diagnosis and 10% of them needed pharmaceutical intervention. The degree and course of cardiotoxicity seem to differ significantly between our patients, suggesting that both the underlying genetic predisposition and the presence of various other risk factors contribute to the severity of its manifestation.

Keyword(s): Anthracycline, Children, Late effects, Toxicity

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