Early Cardiovascular Events Following Anticancer Treatment in Children with Acute Lymphoblastic Leukemia and Hodgkin Lymphoma— Insights from a Retrospective Observational Study

Background: Acute lymphoblastic leukemia (ALL) and Hodgkin lymphoma (HL) are the most frequent cancer diseases in children. Its treatment protocols usually include anthracyclines resulting in a relevant risk of cardiotoxic side effects. While there is increasing evidence of long-term cardiotoxicity arising from chemotherapy, limited data exist on cardiotoxic damage in the early postchemotherapy period. The purpose of our study was to describe early cardiotoxicity expression and identify associated risk factors in children with ALL and HL.

Methods: Data on demographics, clinical features, neoplastic diagnosis, therapeutic regimens, and cardiac evaluations were retrospectively collected from children and adolescents with ALL and HL aged 0 to 18 years admitted to our hospital between January 2013 and December 2019.

Results: One hundred and nine subjects (57.8% males) were enrolled, 84 with ALL and 25 with HL. The mean age for ALL and HL was 7.3 years and 13.3 years, respectively. Follow-up period was 5.6 years (range 2.6–9.4 years). Early cardiovascular (CV) events following anticancer treatment occurred in 69% of ALL patients and 68% of HL patients, including at least one of the following: newly detected echocardiographic abnormalities (including LV systolic and diastolic dysfunction, and valvulopathies), ECG alterations and arrhythmias, thrombotic events, pericardial diseases, and systemic hypertension. Thirty-two percent of ALL and 36% of HL patients presented with more than one CV event. The majority of early CV events were asymptomatic findings and showed spontaneous recovery. Only three patients (2.7%) presented with dilated cardiomyopathy requiring intensive care admission, one of these needed continuing administration of cardioactive medication for chronic heart failure during follow-up. Most of the events occurred within the first 12 months of antineoplastic therapy after the diagnosis, the frequency peak was between day 100 and 220, except for systemic hypertension where 50% of all events were during the first 3 weeks after initiation of anticancer treatment. Risk factors for cardiotoxicity were age at diagnosis >14 years (p < 0.05), higher ALL risk score (p < 0.05), and recurrence of the oncologic disease (p < 0.05).

Conclusion: According to our results, more than two-thirds of all children with ALL and HL suffered from at least one early CV event following anticancer treatment. Although most of the events were subclinical and self-limiting, a few patients had life-threatening cardiotoxic CV events, thus emphasizing the need for comprehensive cardiovascular workup during and following anticancer treatment.

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Artikel online veröffentlicht:
11. Februar 2025