Background: Acute lymphoblastic leukemia (ALL) and Hodgkin lymphoma (HL) are the most frequent
cancer diseases in children. Its treatment protocols usually include anthracyclines
resulting in a relevant risk of cardiotoxic side effects. While there is increasing
evidence of long-term cardiotoxicity arising from chemotherapy, limited data exist
on cardiotoxic damage in the early postchemotherapy period. The purpose of our study
was to describe early cardiotoxicity expression and identify associated risk factors
in children with ALL and HL.
Methods: Data on demographics, clinical features, neoplastic diagnosis, therapeutic regimens,
and cardiac evaluations were retrospectively collected from children and adolescents
with ALL and HL aged 0 to 18 years admitted to our hospital between January 2013 and
December 2019.
Results: One hundred and nine subjects (57.8% males) were enrolled, 84 with ALL and 25 with
HL. The mean age for ALL and HL was 7.3 years and 13.3 years, respectively. Follow-up
period was 5.6 years (range 2.6–9.4 years). Early cardiovascular (CV) events following
anticancer treatment occurred in 69% of ALL patients and 68% of HL patients, including
at least one of the following: newly detected echocardiographic abnormalities (including
LV systolic and diastolic dysfunction, and valvulopathies), ECG alterations and arrhythmias,
thrombotic events, pericardial diseases, and systemic hypertension. Thirty-two percent
of ALL and 36% of HL patients presented with more than one CV event. The majority
of early CV events were asymptomatic findings and showed spontaneous recovery. Only
three patients (2.7%) presented with dilated cardiomyopathy requiring intensive care
admission, one of these needed continuing administration of cardioactive medication
for chronic heart failure during follow-up. Most of the events occurred within the
first 12 months of antineoplastic therapy after the diagnosis, the frequency peak
was between day 100 and 220, except for systemic hypertension where 50% of all events
were during the first 3 weeks after initiation of anticancer treatment. Risk factors
for cardiotoxicity were age at diagnosis >14 years (p < 0.05), higher ALL risk score (p < 0.05), and recurrence of the oncologic disease (p < 0.05).
Conclusion: According to our results, more than two-thirds of all children with ALL and HL suffered
from at least one early CV event following anticancer treatment. Although most of
the events were subclinical and self-limiting, a few patients had life-threatening
cardiotoxic CV events, thus emphasizing the need for comprehensive cardiovascular
workup during and following anticancer treatment.
