TOPLINE

In a US cohort study of adults on anthracycline-based therapy for hematologic cancers, only 1%-2% received strategies to lower the risk for treatment-related heart damage.

METHODOLOGY

• Many adults with hematologic cancers receive anthracyclines at cumulative doses that carry substantial risk for cardiotoxic effects. Two cardioprotective strategies have shown efficacy in curbing that risk: liposomal anthracycline formulations and intravenous dexrazoxane, which is used in nearly all cases of pediatric acute myeloid leukemia (AML). Little is known about the use of cardioprotection in adult patients or whether it might compromise disease response.
• Researchers used the US-based Flatiron Health Research Database to identify 13,331 adults who received frontline anthracycline chemotherapy for AML, diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, or mantle cell lymphoma between 2014 and 2024.
• Cardioprotection was defined as receipt of liposomal anthracyclines or dexrazoxane during frontline therapy.
• Multivariable Cox proportional hazards models estimated hazard ratios (HRs) for the association between cardioprotection and overall survival, adjusting for patient demographics, insurance status, cytomolecular risk features, and practice-level variations.

TAKEAWAY

• Use of cardioprotection was exceedingly rare in patients with follicular or mantle cell lymphoma, so analyses were restricted to patients with AML or DLBCL. Only 2.4% and 1.1% of those patients, respectively, received cardioprotective strategies.
• Among patients with AML who received cardioprotection, the strategy was almost exclusively a liposomal anthracycline (CPX-351). Its use was not associated with worse overall survival in adjusted analyses (HR, 1.45; 95% CI, 0.95-2.21).
• In patients with DLBCL, neither liposomal anthracycline (HR, 1.00; 95% CI, 0.60-1.66) nor dexrazoxane (HR, 1.18; 95% CI, 0.61-2.29) use was associated with worse overall survival.
• Among eligible patients with DLBCL, only 1.5% received R-CEOP, a frontline non-anthracycline regimen, suggesting that patients perceived to be at higher baseline risk for cardiotoxic effects may preferentially receive non-anthracycline regimens rather than cardioprotection strategies.

IN PRACTICE

“In this large national clinical practice cohort study, cardioprotective strategies were rarely used in adults receiving frontline anthracycline-based therapy for hematologic malignant neoplasm,” the study authors wrote. Potential reasons, they added, include a lack of prospective data on adult patients and concerns about reduced antitumor efficacy.

“Prospective randomized studies are needed to evaluate the safety and efficacy of broader cardioprotection use, particularly dexrazoxane, in adult hematologic malignant neoplasms,” they concluded.

SOURCE

The study, led by Alexis Chen Boulter, MD, of Children’s Hospital of Philadelphia in Philadelphia, was published online as a research letter in JAMA Network Open.

LIMITATIONS

Data were lacking on baseline cardiac function, frailty, and intensive care use. The small number of patients who received cardioprotection limited the statistical power to detect survival differences or make conclusions regarding treatment safety. The study was subject to differential follow-up and attrition inherent to electronic health record data.

DISCLOSURES

The study was funded by the National Institutes of Health and the Pennsylvania Department of Health. Several authors disclosed receiving fees or grants from AbbVie, Amgen, Novartis, and other companies outside of the submitted work. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.