Eva M Hau1, Julien N Caccia2, Rahel Kasteler1, Ben Spycher3, Thomas Suter4, Roland A Ammann2, Nicolas X von der Weid5, Claudia E Kuehni1. 1. Swiss 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. 2. Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland. 3. Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland. 4. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. 5. Department of Paediatrics, University Children's Hospital, Basel, Switzerland.
Abstract
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.
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.
Authors: Theodore W Laetsch; Shannon L Maude; Adriana Balduzzi; Susana Rives; Henrique Bittencourt; Michael W Boyer; Jochen Buechner; Barbara De Moerloose; Muna Qayed; Christine L Phillips; Michael A Pulsipher; Hidefumi Hiramatsu; Ranjan Tiwari; Stephan A Grupp Journal: Leukemia Date: 2022-04-14 Impact factor: 12.883
Authors: Eleanor Kane; Sally Kinsey; Audrey Bonaventure; Tom Johnston; Jill Simpson; Debra Howell; Alexandra Smith; Eve Roman Journal: BMJ Open Date: 2022-03-07 Impact factor: 2.692