Retrospective analysis of AML patients to identifiy a higher risk of anthracycline-associated cardiac toxicity in Hispanic patients.

Retrospective analysis of AML patients identifies a higher risk of anthracycline associated cardiac toxicity in Hispanic patients. Background: Acute Myeloid Leukemia (AML) is the most common acute leukemia in adults. The development of AML is characterized by maturation arrest of hematopoietic precursors in the bone marrow. The standard treatment for AML includes cytarabine and an anthracycline in a 7+3 regimen. Toxicities associated with remission induction include myelosuppression, rash, and cardiac toxicity associated with anthracycline chemotherapy. Several studies have identified risk factors associated with cardiac toxicity including young age and coronary artery disease risk factors such as hypertension, obesity, diabetes mellitus, and high cholesterol. In the present retrospective review, we investigated factors associated with development of cardiac toxicity associated with anthracycline chemotherapy for AML induction. Methods: Individual health records of consecutive patients diagnosed with AML at Loma Linda University Medical Center between January 2012 and December 2017 were analyzed retrospectively. Approval was obtained from the Institutional Review Board prior to initiating the study. Data was analyzed using Chi Squared analysis, multivariate analysis, and the Kaplan Meier method. Results: A total of 53 adult patients were identified. The median age was 59 years, 47% of patients were female, 28% of patients were Hispanic, 64% were Caucasian, and 8% were other ethnicities. Of these patients, 59% received standard induction with 7+3. Interestingly, Hispanics were 7 times more likely to experience anthracyclineassociated cardiomyopathy after than Caucasians (95% CI 1.18 - 41.36). After adjusting for comorbidities, the risk remained statistically significant. Conclusions: In the present study we identified Hispanic ethnicity as a risk factor for the development of anthracycline-associated cardiomyopathy. This ethnic predisposition is of significant clinical interest and warrants further prospective validation and further analysis as to the possible underlying genetic mechanisms responsible for this observation.