Congestive heart failure among children with acute leukemia: a population-based matched cohort study

Abstract

The purpose was to describe the incidence and risk factors of congestive heart failure (CHF) among children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). We included 2053 children (≤18 years) with first primary ALL and AML diagnosed 1992–2010 and registered in the Pediatric Oncology Group of Ontario Networked Information System. We identified CHF events through linked administrative databases. At 10 years, the cumulative incidence of CHF was 1.7% in ALL and 7.5% in AML. Factors associated with CHF in ALL were female gender, age <1 year at cancer diagnosis, irradiation and cumulative anthracycline dose ≥250 mg/m². Irradiation was the only risk factor in AML patients. Of the 23 patients with CHF during active therapy, one developed CHF following treatment completion. Incidence of CHF were 1.7% in ALL and 7.5% in AML. Most with CHF during active therapy did not develop CHF after treatment completion.

Keywords:

• Cardiotoxicity after cancer therapy
• ALL
• AML
• congestive heart failure
• anthracycline-related cardiotoxicity
• irradiation

Acknowledgements

We thank the Pediatric Oncology Group of Ontario for enabling access to select data used in this study. The authors would like to thank the TSUF from The Hospital for Sick Children Research Institute for supporting the project. D.C. was supported by a Northbridge cancer research fellowship from the Garron Family Cancer Center, Toronto. D.C. was also a recipient of American Society of Hematology Clinical Research Training Institute award (2015–2016) and would like to thank the program for assistance with proposal development and methodology. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institutes of Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2018.1474522.