Need for routine examination of left ventricular ejection fraction in patients with AML

Khan, Hiba; Gardner, Kelda M.; Shaw, Cheng‐Mei; Halpern, Anna B.; Huebner, Emily M.; Percival, Mary‐Elizabeth M.; Mirahsani, Sarah; Sorror, Mohamed L.; Becker, Pamela S.; Walter, Roland B.; Estey, Elihu H.

doi:10.1038/s41375-019-0637-z

Cited by 1 publication

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“… 14 EF evaluation can be expensive and can delay the initiation of life-saving chemotherapy, and these results suggest that it is unnecessary more often than not. 15 In contrast, a previous analysis of 97 randomized controlled trials in hematologic malignancies, not limited to AML and MDS, determined that cardiac eligibility criteria were significantly associated with observed adverse events in a way that hepatic and renal eligibility criteria were not. 16 Cardiac eligibility criteria may act as a surrogate for other co-morbidities and may predict toxicity, but the authors of that study conclude that exclusion criteria are often too broad and not applicable.…”

Section: Discussionmentioning

confidence: 93%

Survival of patients with newly diagnosed high-grade myeloid neoplasms who do not meet standard trial eligibility

et al. 2020

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Few patients with cancer, including those with acute myeloid leukemia and high-grade myeloid neoplasms, participate in clinical trials. Broadening standard eligibility criteria may increase clinical trial participation. In this retrospective single-center analysis, we identified 442 consecutive newly diagnosed patients from 2014 to 2016. Patients were considered “eligible” if they had a performance status 0-2, normal renal and hepatic function, no recent solid tumor, left ventricular ejection fraction (EF) ≥50%, and no history of congestive heart failure (CHF) or myocardial infarction (MI); “ineligible” patients failed to meet one or more of these criteria. We included 372 patients who received chemotherapy. Ineligible patients represented 40% of the population and had a 1.79-fold greater risk of death (95% Confidence Interval [CI]: 1.37-2.33) than eligible patients. Very few patients had cardiac comorbidities, including 2% with low EF, 4% with prior CHF, and 5% with prior MI. In multivariable analysis, ineligibility was associated with decreased survival (Hazard ratio [HR] 1.44; 95% CI: 1.07-1.93). Allogeneic transplantation, performed in 150 patients (40%), was associated with improved survival (HR 0.66, 95% CI: 0.48-0.91). Therefore, standard eligibility characteristics identify a patient population with improved survival. Further treatment options are needed for patients considered ineligible for clinical trials.

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Section: Discussionmentioning

confidence: 93%