Cardiovascular disease after childhood acute lymphoblastic leukaemia: a cohort study.

Hau, Eva M.; Caccia, Julien N; Kasteler, Rahel; Spycher, Ben; Suter, Thomas; Ammann, Roland A.; von der Weid, Nicolas X; Kuehni, Claudia E. (2019). Cardiovascular disease after childhood acute lymphoblastic leukaemia: a cohort study. Swiss medical weekly, 149, w20012. EMH Schweizerischer Ärzteverlag 10.4414/smw.2019.20012

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BACKGROUND AND AIMS Cardiovascular diseases (CVD) increase late morbidity and mortality in survivors of acute lymphoblastic leukaemia (ALL). We compared the risk of CVD in ALL survivors to siblings, examined time trends, quantified treatment-related risks, and investigated whether risk extends beyond patients treated with anthracyclines and chest radiotherapy. METHODS The Swiss Childhood Cancer Survivor Study assessed CVD by patient questionnaire in 5-year ALL survivors diagnosed between 1976 and 2005 and their siblings. Participants were asked whether a physician had ever told them that they had hypertension, arrhythmia, heart failure, myocardial infarction, angina pectoris, stroke, thrombosis or valvular problems. We investigated treatment-related risk factors for CVD using multivariable logistic regression, adjusting for demographic and socioeconomic factors, BMI, smoking, diabetes mellitus, alcohol consumption and physical activity. RESULTS We contacted 707 survivors and 1299 siblings, 511 (72%) and 709 (55%) of whom responded, respectively. Survivors had a higher risk of developing CVD than siblings (odds ratio [OR] 1.9, 95% confidence interval 1.3–2.8), in particular heart failure (OR 13.9, 1.8–107.4). Compared to patients treated 1976–85, the risk of CVD was 1.4 (0.7–2.8) for those treated 1985–1994 and 1.5 (0.6–3.7) for those treated 1995–2005. The overall CVD risks after anthracycline treatment (OR 3.1, 2.0–4.7), haematopoietic stem cell transplantation (OR 8.0, 2.4–26.9) or relapse (OR 4.1, 1.9–8.8) were increased compared to those of siblings, while the CVD risks of survivors treated without anthracycline or chest radiotherapy were similar (OR 1.0; 0.5–2.0). CONCLUSIONS Despite attempts to reduce cardiotoxicity in childhood cancer treatment, CVD risks in ALL survivors treated more recently do not seem to have declined.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Hau Grosch, Eva-Maria; Caccia, Julien Noël; Kasteler, Rahel; Spycher, Ben; Suter, Thomas; Ammann, Roland and Kühni, Claudia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1424-7860

Publisher:

EMH Schweizerischer Ärzteverlag

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

13 Mar 2019 13:32

Last Modified:

25 Oct 2019 13:14

Publisher DOI:

10.4414/smw.2019.20012

PubMed ID:

30852834

Additional Information:

Caccia and Hau equally contributed to this work

BORIS DOI:

10.7892/boris.127868

URI:

https://boris.unibe.ch/id/eprint/127868

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