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Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis

David Kuron1,2, Alexander Pohlmann3, Linus Angenendt3

  • 1Department of Medicine A, University Hospital Münster, 48149, Münster, Germany. David.kuron@uksh.de.

Annals of Hematology
|February 7, 2023
PubMed

Insights

Anthracycline-free thioguanine, cytarabine, and amsacrine (TAA) chemotherapy is not recommended for acute myeloid leukemia (AML) patients with cardiac issues due to high early mortality. Novel agents should be considered instead.

Area of Science:

  • Hematology
  • Oncology
  • Cardiology

Background:

  • Intensive chemotherapy, including anthracyclines, is standard for acute myeloid leukemia (AML).
  • Patients with cardiac disease may be ineligible for anthracycline-based treatments.
  • Previous studies suggested anthracycline-free TAA chemotherapy as a potential alternative.

Purpose of the Study:

  • To evaluate the efficacy and safety of anthracycline-free TAA chemotherapy in AML patients with cardiac comorbidities.
  • To assess outcomes including event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS).

Main Methods:

  • Systematic retrospective single-center analysis of 31 AML patients with cardiac comorbidities (coronary heart disease, cardiomyopathy).
  • Patients received TAA (thioguanine, cytarabine, amsacrine) as induction chemotherapy.
  • Ejection fraction (EF) was assessed; patients with EF <30% were considered unfit for intensive therapy.

Main Results:

  • Median ejection fraction (EF) was 48% (range 30-67%).
  • Event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS) were 1.61, 5.46, and 13.6 months, respectively.
  • High early mortality (within 30 days) due to infectious complications was observed.

Conclusions:

  • TAA chemotherapy is not recommended as a substitute for standard induction in AML patients with significant cardiac disease.
  • High early mortality rates limit its use.
  • Alternative strategies, such as hypomethylating agents plus venetoclax, should be considered for these patients.

Keywords:
AMLAcute myeloid leukemiaAmsacrineCardiac comorbiditiesInduction therapy

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