J Cancer 2019; 10(24):6161-6169. doi:10.7150/jca.36948

Research Paper

Long-term cardiac-specific mortality among 44,292 acute myeloid leukemia patients treated with chemotherapy: a population-based analysis

Guangli Li1*, Zhijuan Zhou1,2*, Wencong Yang3*, Hao Yang1, Xiuwu Fan1, Yuelan Yin1,2, Liyun Luo1,2, Jinyou Zhang1, Niujian Wu1, Zibin Liang4✉, Jianting Ke5✉, Jian Chen1,2,6✉

1. Department of Cardiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.
2. Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.
3. Department of Cardiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518017, Guangdong, China.
4. Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China.
5. Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.
6. Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.
* Dr. Guangli Li, Zhijuan Zhou and Wencong Yang have equally contributed to this article.

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Citation:
Li G, Zhou Z, Yang W, Yang H, Fan X, Yin Y, Luo L, Zhang J, Wu N, Liang Z, Ke J, Chen J. Long-term cardiac-specific mortality among 44,292 acute myeloid leukemia patients treated with chemotherapy: a population-based analysis. J Cancer 2019; 10(24):6161-6169. doi:10.7150/jca.36948. Available from http://www.jcancer.org/v10p6161.htm

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Abstract

Background: Acute myeloid leukemia (AML) is a common hematological malignancy treated with regimens containing anthracycline, an agent with cardiotoxicity. However, the cardiac-specific mortality in AML patients receiving chemotherapy remains unknown.

Methods: In this population-based study, patients diagnosed with AML between 1973 and 2015 were identified in the Surveillance, Epidemiology, and End Results database. Cumulative mortality by cause of death was calculated. To quantify the excessive cardiac-specific death compared with the general population, standardized mortality ratios (SMRs) were calculated. Multivariate Cox regression analyses were performed to identify risk factors associated with cardiac-specific death and AML-specific death.

Results: A total of 64,679 AML patients were identified between 1973 and 2015; 68.48% of patients (44,292) received chemotherapy. Among all possible competing causes of death, AML was associated with the highest cumulative mortality. The AML patients who received chemotherapy showed excessive cardiac-specific mortality compared with the general population, with an SMR of 6.35 (95% CI: 5.89-6.82). Age, year of diagnosis, sex, and marital status were independently associated with patient prognosis.

Conclusion: Cardiac-specific mortality in AML patients receiving chemotherapy is higher than that in the general population.

Keywords: acute myeloid leukemia, chemotherapy, cardiac-specific death, epidemiology and cohort study.