A new study, led by Jesse Geels and colleagues from the Netherlands, systematically analyzed 41 studies covering 5,995 patients with acute myeloid leukaemia (AML) treated with anthracycline-based regimens. The pooled proportion of heart failure among these patients was 3.2%, with important variation by the type of anthracycline used: 2.3% for daunorubicin, 5.0% for idarubicin, and 10.2% for mitoxantrone. Secondary cardiovascular adverse events were also common but often underreported.
Cardiotoxicity Remains a Major Concern
Anthracyclines have long been recognized for their effectiveness in achieving remission but are also notorious for dose-dependent cardiotoxicity, particularly in people with existing cardiovascular risk factors. Current grading systems often miss asymptomatic declines in heart function as they primarily rely on observable symptoms, enabling early subclinical cardiotoxicity to go undetected.
Gaps in Monitoring and Future Recommendations
The study found that cardiac monitoring during therapy was infrequently performed, and reporting of cardiovascular adverse events lacked consistency. Failure to detect or report early signs of heart dysfunction means that opportunities for timely intervention may be missed, potentially allowing reversible damage to progress to advanced heart failure. Enhanced surveillance and a revision of adverse event grading systems are needed, with a particular focus on subclinical indicators.
Implications for Clinical Practice in AML
Clinicians managing patients with acute myeloid leukaemia (AML) treated with anthracyclines should prioritise routine cardiac monitoring regardless of the presence of symptoms, to identify early signs of cardiotoxicity. It is essential to report all cardiovascular adverse events using standardised criteria to ensure consistent data collection and to better understand the real impact of these therapies on heart function. Early detection and timely intervention can prevent the progression to advanced heart failure, improving long-term outcomes for AML patients. Implementing comprehensive surveillance protocols, including echocardiography and biomarkers, will enable more effective management of cardiotoxicity.
Reference
Geels J et al. Heart failure in patients with acute myeloid leukemia (AML) treated with anthracycline agents during remission induction therapy: a systematic review and meta-analysis. Leukaemia. 2025; https://doi.org/10.1038/s41375-025-02753-w.
