This case highlights the risk of acute, potentially fatal heart failure following dose-intensified anthracycline (daunorubicin) therapy in AML patients, even after initial recovery of ejection fraction.
Alerts clinicians to fatal HF recurrence risk despite EF recovery after daunorubicin in AML; leaves open optimal surveillance and transplant timing.
Heart failure following anthracycline treatment is usually chronic, irreversible, and related to life time dose. We present a patient with Acute Myeloid Leukemia (AML) who developed Heart failure soon after dose intensified treatment with daunorubicin, with a decrease in Ejection Fraction (EF) from 60% to as low as 10% six months after initial treatment. The patient was managed medically, his EF increased to greater than 50%. With this improvement in EF the patient was treated with reinduction chemotherapy and proceeded to hematopoietic stem cell transplantation. Following transplantation, the patient again developed heart failure, which contributed to his death. While anthracycline dose intensification can be effective in the treatment of AML, there is a risk of heart failure which requires further study.
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Lawrence Druhan Omotayo Fasan (2015) studied this question.
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