Synopsis

Keywords: Cardiomyopathy, Cancer

The stage of chemotherapy in children with ALL is a long process, and the myocardial damage caused by chemotherapy is still unknown. The different chemotherapy stages may have different degrees of myocardial damage. In this study, cardiac magnetic resonance was used to evaluate myocardial strain in ALL patients at different stages of treatment, and it was found that myocardial strain reduction was more pronounced in the early stages of treatment, and that global strain was a risk factor for adverse clinical outcomes.

Objective: Myocardial toxicity caused by cancer therapy has gradually become the main cause of long-term poor prognosis of tumor survivors, and acute lymphoblastic leukemia(ALL) in childhood is one of the most common cancer with long time therapy. However, the assessment of myocardial injury is still a challenge in clinical. In this study, we aimed to evaluate the myocardial deformation by cardiac magnetic resonance at different stages and further to explore the prognostic value in pediatric leukemia patients. Materials and methods There were 245 children diagnosed with ALL and receiving cardiac magnetic resonance examination in our hospital were included from January 2018 to December 2021 , as well as 85 normal children matching the gender and age of the patients were enrolled. Children were grouped according to different stage of treatment (< 54 weeks, 54-125 weeks, > 125 weeks). All patients were followed up one year after completion of MRI, with clinical adverse events defined as ICU treatment and/or death from any cause. The left ventricle myocardial strain parameters including global and region of radial strain (RS), circumferential strain (CS) and longitudinal strain(LS) . the K-M analysis and univariate Cox survival analysis were used to investigate the predictive value of CMR parameters for clinical adverse prognosis. Results For the myocardial deformation assessment, GRS and GLS in patients treated within 54 weeks were significantly lower than those in normal control group; GCS and GLS in patients treated for more than 125 weeks were lower than those in normal control group (all P < 0.05). GRS, GCS, and GLS were slightly lower in patients treated for less than 54 weeks and more than 125 weeks than in patients treated for 54 to 125 weeks. the correlation analysis showed The GRS was significantly negatively correlated with the cumulative dose of daunorubicin in patients treated within 54 weeks (r=-0.26,P=0.013) and over 125 weeks (r=-0.20, P=0.044) (Figure 16). The GLS was negatively correlated with the cumulative dose within 54 weeks of treatment (r=-0.33, P=0.001). The median follow-up time was 1.2 years and the mean time was 1.6 years. Cox survival analysis showed that GRS(HR=0.89; 95%CI: 0.79-0.99) and GLS(HR= 1.31; 95%CI: 1.01-1.71) was a risk predictor of clinical adverse prognosis (P < 0.05). the K-M analysis of clinical poor prognosis showed that patients with GLS ＜-18% had a significantly lower survival rate than patients with ≥18% (HR:6.97, 95%CI:1.07-62.39, P= 0.043). Conclusions The myocardial strain were decreased in ALL children during and after treatment, and the decrease of myocardial strain is associated with clinical adverse outcomes.

Acknowledgements

NA