Cancer recurrence and mortality after pediatric heart transplantation for anthracycline cardiomyopathy: A report from the Pediatric Heart Transplant Study (PHTS) group

Abstract

We aimed to determine whether malignancy after pediatric HTx for ACM affects overall post-HTx survival. Patients <18y listed for HTx for ACM in the PHTS database between 1993 and 2014 were compared to those with DCM. A 2:1 matched DCM cohort was also compared. Wait-list and post-HTx survival, along with freedom from common HTx complications, were compared. Eighty subjects were listed due to ACM, whereas 1985 were listed for DCM. Although wait-list survival was higher in the ACM group, post-HTx survival was lower for the ACM cohort. Neither difference persisted in the matched cohort analysis. Primary cause of death in the ACM group was infection, which was higher than the DCM group. Malignancy rates were not different. All ACM malignancies were due to PTLD without primary cancer recurrence or SMN. Long-term graft survival after pediatric HTx for ACM is no different than for matched DCM peers, nor is there an increased risk of any malignancy. However, risk of infection and death from infection after HTx are higher in the ACM group. Further studies are needed to assess the effects of prior chemotherapy on susceptibility to infection in this group.

State of the art review: Chemotherapy-induced cardiotoxicity in children

“…The main purpose of the study was to report the incidence of cancer recurrence, which occurred in only one patient. A larger and more recent study of 80 transplanted CIC patients from the Pediatric Heart Transplant Study Group reported no difference in graft survival or malignancy . However, the risk of infection and death from infection was higher in this population.…”

“…A larger and more recent study of 80 transplanted CIC patients from the Pediatric Heart Transplant Study Group reported no difference in graft survival or malignancy. 108 However, the risk of infection and death from infection was higher in this population. From this study, one can calculate that approximately 10 heart transplants are performed for CIC annually.…”

Management of Patients with Malignancy before Heart Transplantation

“…Second, treatment of cancer by chemotherapy such as anthracyclines [3][4][5][6][7] cause damage of the cardiomyocytes and can result in chemotherapy-related cardiomyopathy (CCMP). This is especially true for pediatric patients, in whom this type of treatment is used [8]. In spite of preventive measures, end-stage heart failure (ESHR) might develop in 2 to 4% of these patients [3], for whom OHT is the only option to alter its natural course [9].…”

Heart transplantation for anthracycline cardiomyopathy: Pump up the volume

“…In this issue of Pediatric Transplantation , Bock and colleagues provide data aimed to investigate outcomes in the AC population using the largest cohort of heart transplant recipients to date, and encompassing approximately 80% of pediatric heart transplants worldwide over the last decade . Eighty pediatric patients with AC were listed for transplant.…”

“…The Bock report also describes a significant difference in the AC vs DCM post‐transplant death rate due to infection. The difference is significant, with infection being the leading cause of death in the AC group and accounting for 30% of deaths post‐transplant . The Childhood Cancer Survivor Survey (CCSS) has shown that survivors are 1.6 to 2.7 times more likely to be hospitalized for infection compared to their age and sex matched general population even though central venous access lines are typically removed promptly at the end of therapy, and antimicrobial prophylaxis is given for only brief periods of 3‐6 months in oncology patients and for 1 year in those who receive a bone marrow transplant .…”