Cardioprotection Rarely Used in Adults With Blood Cancers

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.

Results
In patients with follicular lymphoma or mantle cell lymphoma, cardioprotection was used extremely rarely, so the analysis was limited to patients with acute myeloid leukemia or diffuse large B‑cell lymphoma. Only 2.4 % and 1.1 % of these patients, respectively, received cardioprotective drugs. Among patients with acute myeloid leukemia who received cardioprotection, liposomal anthracycline (CPX‑351) was used almost exclusively. Its use was not associated with a deterioration in overall survival according to the results of the adjusted analysis (HR 1.45; 95% CI 0.95–2.21).
In patients with diffuse B-cell lymphoma, the use of liposomal anthracycline (HR 1.00; 95% CI 0.60–1.66) and dexrazoxane (HR 1.18; 95% CI 0.61–2.29) It was not associated with a deterioration in overall survival.
Among patients with diffuse large B‑cell lymphoma who met the selection criteria, only 1.5 % received R‑CEOP — a first‑line treatment regimen without anthracyclines. This suggests that patients with an increased baseline risk of developing cardiotoxicity are more likely to receive treatment regimens without anthracyclines rather than cardioprotective drugs.

In this large national clinical practice cohort study, cardioprotective strategies were rarely used in adults receiving frontline anthracycline-based therapy for hematologic malignant neoplasm.

Potential reasons, they added, include a lack of prospective data on adult patients and concerns about reduced antitumor efficacy.

 

https://www.medscape.com/viewarticle/cardioprotection-rarely-used-adults-blood-cancers-2026a1000tcp?src=