Cardiotoxicity in patients with acute myeloid leukaemia following anthracycline-containing chemotherapy: A population-based matched cohort study

Anthracycline-containing chemotherapy is associated with cardiovascular diseases (CVDs). While knowledge regarding the extent of cardiotoxicity in adult patients with acute myeloid leukaemia (AML) is sparse, anthracyclines remain a key component in the treatment. To address this, 1379 adult AML patients treated with anthracycline-containing chemotherapy between 2000 and 2020 were matched to 6895 comparators from the Danish background population and followed for a median of 11.8 and 12.8 years respectively. The risk of congestive heart failure (CHF) was higher in AML patients compared to the comparators throughout the entire follow-up period with adjusted hazard ratios (HRs) ranging from 15.0 (95% CI: 7.02-32.1) after 3 months to 2.68 (95% CI: 1.67-4.30) after 15 years. The risk of non-CHF CVD was initially higher in AML patients (adjusted HR: 9.16 [95% CI: 6.61-12.7] after 3 months) but converged to that of the comparators after approximately 10 years. Among AML patients, increasing age and male sex were identified as risk factors of CHF and non-CHF CVD. In summary, AML patients treated with anthracycline-containing chemotherapy had an elevated risk of CVD, particularly during the first years after treatment initiation. Increased focus on early detection and cardioprotective strategies may help mitigate the harmful effects of anthracyclines in the future.