Study of baseline echocardiography and treatment endpoint in patients with acute lymphoblastic leukemia

Abstract

Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Anthracyclines are among the most common and effective drugs for the treatment of children ALL. However, long-term consumption and higher doses of these drugs may lead to toxic effects on the heart of children. For this purpose, in the present study, the baseline and posttreatment echocardiography status was evaluated in children with ALL during 7 years. Materials and Methods: This retrospective cross-sectional study was performed on 53 children with ALL who were under the age of 18 years. Different factors including risk groups, age, gender, white blood cells, dosage, and duration of treatment, as well as baseline and posttreatment echocardiography findings including EF, E/E/, E//A/, MVE/A were evaluated in all patients. Results: All enrolled patients had not any abnormalities in the baseline echocardiography preventing the beginning of chemotherapy. The results of this study did not show a significant difference in mean baseline echocardiography parameters after treatment including EF̨E/E/̨E//A/̨, MVE/A. In addition, there was no significant difference in mean EF, E//A/̨, MVE/A, and ̨E/E/before and after treatment among SR, IR, and HR groups. Although there was no significant difference in the mean EF, E//A/, and MVE/A before and after treatment between male and female sex, the mean E/E/after chemotherapy in girls (8.5 ± 0.7) was significantly higher than the mean before treatment (6.85 ± 1.5) (P < 0.001). It was also higher than the mean in boys (7.04 ± 0.99) (P = 0.019). Although there was no significant relationship between the duration of chemotherapy and the mean of EF̨E/E/̨E//A/̨, MVE/A after treatment, high dose of the drug was found to be significantly associated with a gradual decrease of EF or systolic function of the heart (P < 0.001). There was no significant relationship between drug dose and other parameters of echocardiography including E/A/, MVE/A, and E/E/after treatment. Conclusion: It appears that chemotherapy should not be delayed by echocardiography. Based on the findings presented herein, increasing the dose of anthracycline can be considered as an effective factor in reducing the systolic function of the heart (EF reduction). On the other hand, chemotherapy in the period of 1 to 5.3 years does not seem to have a significant effect on the mean parameters of EF, E/E/, E//, and MVE/A although another study with higher sample size and follow-up is needed to confirm these results.

Keywords

• acute lymphoblastic leukemia
• anthracycline
• cardiac toxicity
• conventional echocardiography
• tissue doppler echocardiography (tde)