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Cardiovascular disease after childhood acute lymphoblastic leukaemia: a cohort study
Eva M Hau1, Julien N Caccia2, Rahel Kasteler1
1Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland / Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Insights
Adult survivors of childhood acute lymphoblastic leukemia (ALL) face a doubled risk of cardiovascular diseases (CVD). This increased risk, particularly for heart failure, persists even with modern treatments, highlighting the need for long-term cardiac monitoring.
Area of Science:
- Cardiology
- Oncology
- Epidemiology
Background:
- Cardiovascular diseases (CVD) are a significant cause of late morbidity and mortality in survivors of childhood acute lymphoblastic leukemia (ALL).
- Understanding the long-term cardiovascular risks in ALL survivors is crucial for improving their quality of life and survival.
- Previous studies have focused on patients treated with specific therapies like anthracyclines and chest radiotherapy, but the risk profile in a broader ALL survivor population needs further investigation.
Purpose of the Study:
- To compare the risk of developing CVD in ALL survivors to that of their siblings.
- To examine time trends in CVD risk among ALL survivors.
- To quantify treatment-related risks for CVD and determine if the risk extends beyond patients treated with anthracyclines and chest radiotherapy.
Main Methods:
- The Swiss Childhood Cancer Survivor Study utilized patient questionnaires to assess CVD in 5-year ALL survivors diagnosed between 1976 and 2005 and their siblings.
- Participants reported physician-diagnosed conditions including hypertension, arrhythmia, heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems.
- Multivariable logistic regression was employed to investigate treatment-related risk factors, adjusting for demographic, socioeconomic, lifestyle, and clinical factors.
Main Results:
- ALL survivors exhibited a significantly higher risk of CVD compared to siblings (OR 1.9).
- Heart failure was a particularly elevated risk (OR 13.9) among survivors.
- While risks associated with anthracycline treatment, stem cell transplantation, and relapse were increased, survivors treated without anthracycline or chest radiotherapy showed similar CVD risks to siblings (OR 1.0).
Conclusions:
- Cardiovascular disease risks in ALL survivors remain elevated, even in more recent treatment eras.
- Despite efforts to mitigate cardiotoxicity, long-term cardiac surveillance is essential for ALL survivors.
- The study underscores the need for continued research into cardiovascular risk reduction strategies for childhood cancer survivors.
Background And Aims:
Cardiovascular diseases (CVD) increase late morbidity and mortality in survivors of acute lymphoblastic leukaemia (ALL). We compared the risk of CVD in ALL survivors to siblings, examined time trends, quantified treatment-related risks, and investigated whether risk extends beyond patients treated with anthracyclines and chest radiotherapy.
Methods:
The Swiss Childhood Cancer Survivor Study assessed CVD by patient questionnaire in 5-year ALL survivors diagnosed between 1976 and 2005 and their siblings. Participants were asked whether a physician had ever told them that they had hypertension, arrhythmia, heart failure, myocardial infarction, angina pectoris, stroke, thrombosis or valvular problems. We investigated treatment-related risk factors for CVD using multivariable logistic regression, adjusting for demographic and socioeconomic factors, BMI, smoking, diabetes mellitus, alcohol consumption and physical activity.
Results:
We contacted 707 survivors and 1299 siblings, 511 (72%) and 709 (55%) of whom responded, respectively. Survivors had a higher risk of developing CVD than siblings (odds ratio [OR] 1.9, 95% confidence interval 1.3–2.8), in particular heart failure (OR 13.9, 1.8–107.4). Compared to patients treated 1976–85, the risk of CVD was 1.4 (0.7–2.8) for those treated 1985–1994 and 1.5 (0.6–3.7) for those treated 1995–2005. The overall CVD risks after anthracycline treatment (OR 3.1, 2.0–4.7), haematopoietic stem cell transplantation (OR 8.0, 2.4–26.9) or relapse (OR 4.1, 1.9–8.8) were increased compared to those of siblings, while the CVD risks of survivors treated without anthracycline or chest radiotherapy were similar (OR 1.0; 0.5–2.0).
Conclusions:
Despite attempts to reduce cardiotoxicity in childhood cancer treatment, CVD risks in ALL survivors treated more recently do not seem to have declined.
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