OBJECTIVE: Acute lymphobastic leukemia (ALL) remains the most common hematology malignancy in children. Anthracycline improve survival rate but consequently compromise long-term cardiovascular outcome in some patients. The aim of this study is identifying the key factors of early anthracycline induced cardiomyopathy in childhood ALL.
METHODS: We retrospectively reviewed the medical records of 50 children with ALL from 2014-2019 in Dr. Soetomo Academic General Hospital, Surabaya. Patients were treated with chemotherapy using the 2013 ALL Indonesian Protocol. Echocardiography was performed by two pediatric cardiologists, comparing before and after anthracycline therapy (30mg/m 2 daunorubicin). Early cardiomyopathy was defined as decline of left ventricle ejection fraction (LVEF) greater than 10% with a final LVEF <53% during the first year of anthracycline administration. Risk factors such as sex, age, type of ALL, and cumulative dose were identified by using logistic regression. Diagnostic performance of cumulative anthracycline dose was evaluated by receiver operating characteristic (ROC) curve.
RESULT: Early anthracycline induced cardiomyopathy was observed in 5/50 patients. The median cumulative dose of anthracycline was 147.4(range 25 to 315.13)mg/m 2 body surface area (BSA). The median LVEF before and after anthracycline were 70.5(range 52.42 to 98.32)% and 69.4(range 46.01 to 89.91)%, respectively. Thirty three patients (33/50) had decline LVEF. Logistic regression revealed that only cumulative dose >200mg/m 2 BSA (adjusted OR=10.0; 95%CI 1.183 to 83.333; P=0.034) was significantly correlated with cardiomyopathy. The area under the ROC curve was 0.722 (95% CI 0.51 to 0.93). Sensitivity and specificity for 200mg/m 2 cut-off value of cumulative dose were 60% and 89%, respectively.
CONCLUSION: Cumulative dose more than 200mg/m 2 BSA can predict the risk of early anthracycline induced cardiomyopathy in childhood ALL.