Background/Objectives: The incidence of cardiac morbimortality in patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) is unknown. Methods: We analyze the characteristics, incidence, risk factors, and outcomes of cardiac events in AML patients treated for second-line (2L) or third-line (3L) episodes. Results: Among 327 2L AML patients (median age 62 years old), 135 experienced cardiac events, with an incidence of 38.6% non-fatal and 1.3% fatal events at 6 months. The grade 1–2 incidence was 16.8%, and the grade 3–4 incidence was 23.5% at 6 months. Overall, 207 cardiac events occurred in the 2L cohort, the most frequent being hypertension (n = 45), bradycardia (n = 39), QTc prolongation (n = 35), heart failure (n = 33), syncope/presyncope (n = 22), arrhythmia (n = 18), and myocardial ischemia (n = 8). Median OS in the 2L cohort was 9.4 months, 21.4 months in patients with grade 1–2, 8.8 months in patients without a cardiac event, 7.6 months in grade 3–4 patients, and 2.1 months with in 5 patients (p= 0.0035). The multivariate analysis showed prior cardiologic antecedents (p= 0.013), intensive 2L chemotherapy (p= 0.01), and inclusion in a 2L clinical trial (p< 0.001) as independent risk factors for non-fatal cardiac events. Among 189 patients of the 3L cohort, the incidence of non-fatal and fatal cardiac events was 49.2% and 0% at 6 months, respectively. Non-fatal cardiac events were more frequent in patients with prior cardiac antecedents (p= 0.004). Conclusions: In summary, cardiotoxicity is a frequent and challenging complication in R/R AML patients. We identified the risk factors that could be relevant to implementing risk-adapted management guidelines, aiming to reduce morbi-mortality in this difficult-to-treat setting.
背景/目的：复发/难治性急性髓系白血病患者的心脏病发病率和死亡率尚不明确。本研究旨在分析接受二线或三线治疗的AML患者心脏事件的特征、发生率、危险因素及临床结局。方法：我们对接受二线或三线治疗的AML患者发生心脏事件的情况进行回顾性分析。结果：在327例二线治疗AML患者（中位年龄62岁）中，135例出现心脏事件，6个月内非致死性事件发生率为38.6%，致死性事件为1.3%。6个月时1-2级事件发生率为16.8%，3-4级事件为23.5%。二线队列共记录207例心脏事件，最常见类型包括高血压（45例）、心动过缓（39例）、QT间期延长（35例）、心力衰竭（33例）、晕厥/先兆晕厥（22例）、心律失常（18例）及心肌缺血（8例）。二线队列中位总生存期为9.4个月，其中1-2级心脏事件患者为21.4个月，无心脏事件患者为8.8个月，3-4级事件患者为7.6个月，5例致死性事件患者仅2.1个月（p=0.0035）。多变量分析显示，既往心脏病史（p=0.013）、强化二线化疗（p=0.01）及参与二线临床试验（p<0.001）是非致死性心脏事件的独立危险因素。在189例三线治疗患者中，6个月内非致死性与致死性心脏事件发生率分别为49.2%和0%。有心脏病史的患者非致死性心脏事件发生率显著更高（p=0.004）。结论：心脏毒性是R/R AML患者常见且棘手的并发症。本研究识别出的危险因素可为制定风险适应性管理指南提供依据，有助于在这一难治性疾病治疗过程中降低发病率和死亡率。
Cardiotoxicity in Adult Patients with Relapsed or Refractory Acute Myeloid Leukemia
肿瘤(癌症)患者之家