Evaluation of the Utility of Baseline Echocardiogram in Patients With Standard Risk Precursor B-Lymphoblastic...

A routine baseline echocardiogram is often obtained prior to anthracycline administration in children with cancer. The utility of baseline echocardiogram is unclear in patients with standard risk B-cell acute lymphoblastic leukemia (SR B-ALL) as their anthracycline cumulative dose is low. We performed a quality improvement project to understand the clinical utility of routine pre-anthracycline echocardiograms in patients with SR B-ALL.

We retrospectively reviewed baseline echocardiogram results for all children with SR B-ALL treated at a single center from 2011 to 2024. Echocardiographic findings, including any significant structural or functional abnormalities, and the impact of echocardiogram results on anthracycline administration were analyzed.

A total of 286 patients with a median age at diagnosis of 4.13 years [IQR 2.92-5.52] were included. Abnormal echocardiographic findings were reported in six patients (2.1%), but mainly represented incidental findings with only one patient requiring cardiology follow-up for a bicuspid aortic valve. No echocardiogram identified reduced cardiac function or any finding that altered or delayed anthracycline administration.

A routine baseline echocardiogram in patients with SR B-ALL prior to anthracycline administration is without clear utility. Based on these results, a change in practice was implemented in our institution to discontinue routine pre-anthracycline echocardiograms for this population. Omitting this low-value test may reduce unnecessary discomfort in children, family worry, and health-care-related costs.