In a U.S. cohort study reported as a research letter in JAMA Oncology, Zheng et al found that increasing use of dexrazoxane in newly diagnosed children with acute myeloid leukemia (AML) receiving front-line anthracycline treatment has been accompanied by a reduction in intensive care unit (ICU)-level cardiovascular health-care utilization.
Study Details
The study included data from the Pediatric Health Information System, including information on newly diagnosed pediatric patients treated between 2010 and 2021 at 47 institutions across 28 states. Patients were categorized as dexrazoxane initiators if they received dexrazoxane with their first course of anthracycline-containing chemotherapy. The analysis included use of ICU-level cardiovascular resources, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers during front-line chemotherapy. Six-month mortality was used as a proxy for treatment-related mortality.
Key Findings
The analysis included 2,212 pediatric patients with newly diagnosed AML.
The proportion of patients who initiated dexrazoxane increased from 0.5% in 2010 to 98.5% in 2021. Over that period, patients requiring ICU-level cardiovascular care decreased from 24.3% to 11.3%.
In multivariable analyses, patients who initiated dexrazoxane had a significantly reduced risk of requiring ICU-level cardiovascular care during front-line therapy (risk ratio [RR] = 0.64, 95% confidence interval [CI] = 0.52–0.80). No significant differences according to dexrazoxane exposure and need for beta-blocker treatment (RR = 0.96, 95% CI = 0.66–1.40) or ACE inhibitor treatment (RR = 0.95, 95% CI = 0.73–1.24) were observed. Mortality at 6 months was 7.0% vs 8.9% among patients who initiated vs did not initiate dexrazoxane (RR = 0.80, 95% CI = 0.57–1.11).
In a post hoc sensitivity analysis of patients treated during the modern AML treatment era of 2018 to 2021, a significant association of dexrazoxane initiation with ICU-level cardiovascular care was not apparent (RR = 0.80, 95% CI = 0.50–1.27).
As stated by the investigators: “In a large cohort of pediatric patients with AML treated in the [United States], we found a continuous increase in dexrazoxane use over the last decade to near universal uptake by 2021. We observed a corresponding approximately 50% reduction in ICU-level cardiovascular health care utilization over the same period.”
Daniel J. Zheng, MD, MHS, MSHP, of the Division of Oncology, Children’s Hospital of Philadelphia, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by an American Society of Clinical Oncology Conquer Cancer Young Investigator Award in Health Disparities, St Baldrick’s Foundation, and others. For full disclosures of all study authors, visit jamanetwork.com.
