Key result
Third-line relapsed/refractory AML is linked to ~49% non-fatal cardiac event rates, driven by prior history.
Why the study?
The incidence of cardiac morbimortality in patients with relapsed or refractory acute myeloid leukemia was unknown.
What is the incidence and what are the risk factors for cardiotoxicity in adult patients with relapsed or refractory acute myeloid leukemia undergoing second- or third-line therapy?
Cohort (n=516)
What is the incidence and what are the risk factors for cardiotoxicity in adult patients with relapsed or refractory acute myeloid leukemia undergoing second- or third-line therapy?
Cardiotoxicity is a frequent complication in relapsed/refractory AML patients, with prior cardiac history and intensive chemotherapy being significant risk factors.
Answers are grounded in this paper and cite their sources.
Cardiotoxicity risk stratification by prior history may guide monitoring in relapsed AML; leaves open whether interventions reduce events.
Background/Objectives: The incidence of cardiac morbimortality in patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) is unknown. Methods: We analyze the characteristics, incidence, risk factors, and outcomes of cardiac events in AML patients treated for second-line (2L) or third-line (3L) episodes. Results: Among 327 2L AML patients (median age 62 years old), 135 experienced cardiac events, with an incidence of 38.6% non-fatal and 1.3% fatal events at 6 months. The grade 1–2 incidence was 16.8%, and the grade 3–4 incidence was 23.5% at 6 months. Overall, 207 cardiac events occurred in the 2L cohort, the most frequent being hypertension (n = 45), bradycardia (n = 39), QTc prolongation (n = 35), heart failure (n = 33), syncope/presyncope (n = 22), arrhythmia (n = 18), and myocardial ischemia (n = 8). Median OS in the 2L cohort was 9.4 months, 21.4 months in patients with grade 1–2, 8.8 months in patients without a cardiac event, 7.6 months in grade 3–4 patients, and 2.1 months with in 5 patients (p = 0.0035). The multivariate analysis showed prior cardiologic antecedents (p = 0.013), intensive 2L chemotherapy (p = 0.01), and inclusion in a 2L clinical trial (p < 0.001) as independent risk factors for non-fatal cardiac events. Among 189 patients of the 3L cohort, the incidence of non-fatal and fatal cardiac events was 49.2% and 0% at 6 months, respectively. Non-fatal cardiac events were more frequent in patients with prior cardiac antecedents (p = 0.004). Conclusions: In summary, cardiotoxicity is a frequent and challenging complication in R/R AML patients. We identified the risk factors that could be relevant to implementing risk-adapted management guidelines, aiming to reduce morbi-mortality in this difficult-to-treat setting.
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Torres-Miñana et al. (2025) conducted a cohort in Relapsed or Refractory Acute Myeloid Leukemia (n=516). Second-line or third-line treatment was evaluated on Incidence of non-fatal and fatal cardiac events. In patients with relapsed/refractory AML, non-fatal cardiac events occurred in 38.6% of second-line and 49.2% of third-line episodes at 6 months, with prior cardiac history as a key risk factor.
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