Poster Presentation Cancer Survivorship 2019

Cardiovascular health in asymptomatic, anthracycline-treated survivors of childhood leukaemia: a pilot study. (#205)

Treya M Long 1 , Channa E Marsh 1 , Philip Watson 2 , Felicity Lee 3 , Lawrence G Dembo 2 3 , Kaitlyn Lam 3 , Karen E Wallman 1 , Thomas S Walwyn 4 5 , Catherine S Choong 5 6 , Louise H Naylor 1
  1. School of Human Sciences: Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
  2. Envision Medical Imaging, Perth, Western Australia, Australia
  3. Advanced Heart Failure Unit and Cardiac Transplant Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia
  4. Department of Haematology and Oncology, Perth Children's Hospital, Perth, Western Australia, Australia
  5. School of Medicine: Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
  6. Department of Endocrinology, Perth Children's Hospital, Perth, Western Australia, Australia

Childhood leukaemia survivors are at a heightened risk of cardiac mortality due to the late consequences of anthracycline chemotherapy. Timely detection of parameters that may represent early clinical deterioration is crucial for providing a window to treat and prevent complications. Current screening protocols may not be sensitive enough to do this. The present study utilised a battery of alternative tests to characterise cardiovascular health in survivors of childhood leukaemia. Eleven (4 male) long-term (age, 20±3y) survivors were recruited. All were asymptomatic and had normal cardiac health based on resting echocardiogram findings. No survivors had received radiotherapy. Cardiac health was assessed using exercise echocardiography and cardiac magnetic resonance imaging (cMRI), while vascular health was measured using blood pressure and flow mediated dilation (FMD). Anthropometry, body composition (dual x-ray absorptiometry), blood profile and fitness (VO2peak) were also assessed. Eleven similarly aged (22±2y) controls were recruited for comparison. As controls did not undergo blood assessment or cMRI, normative data was used for comparison of these measures. Echocardiography revealed reduced mid-circumferential strain in the survivor hearts at exercise (p=0.003) and recovery (p=0.029). On cMRI, two survivors had clinically abnormal left ventricular ejection fractions <50%. Resting heart rate was higher in the survivors than the controls (p=0.016), while FMD was lower (p=0.026).  The survivors had an increased body-mass (p=0.031), body-mass index (p=0.021), waist (p=0.049) and hip circumference (p=0.020) compared to the controls. They also experienced higher amounts of total (mass, p=0.016), central (percentage, p=0.050; mass, p=0.023), and peripheral (mass, p=0.014) fat. Compared to normative data, three survivors had high total cholesterol, five had high LDL cholesterol, two had low HDL cholesterol and one had high triglycerides. Minute ventilation (p=0.001) and relative VO2peak (p=0.002) were reduced in the survivor group. Childhood leukaemia survivors have an adverse cardiovascular profile that is undetectable using current follow-up screening protocols.