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Risk Factors for Heart Failure among Pan-European Childhood Cancer Survivors : A PanCareSurFup and ProCardio Cohort and Nested Case-Control Study

De Baat, Esmée C. ; Feijen, Elizabeth A.M. ; Reulen, Raoul C. ; Allodji, Rodrigue S. ; Bagnasco, Francesca ; Bardi, Edit ; Belle, Fabiën N. ; Byrne, Julianne ; Van Dalen, Elvira C. and Debiche, Ghazi , et al. (2023) In Journal of Clinical Oncology 41(1). p.96-106
Abstract

PURPOSE Heart failure (HF) is a potentially life-threatening complication of treatment for childhood cancer. We evaluated the risk and risk factors for HF in a large European study of long-term survivors. Little is known of the effects of low doses of treatment, which is needed to improve current treatment protocols and surveillance guidelines.METHODSThis study includes the PanCareSurFup and ProCardio cohort of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009 in seven European countries (N = 42,361). We calculated the cumulative incidence of HF and conducted a nested case-control study to evaluate detailed treatment-related risk factors.RESULTSThe cumulative incidence of HF was 2% (95% CI, 1.7 to 2.2) by age 50 years.... (More)

PURPOSE Heart failure (HF) is a potentially life-threatening complication of treatment for childhood cancer. We evaluated the risk and risk factors for HF in a large European study of long-term survivors. Little is known of the effects of low doses of treatment, which is needed to improve current treatment protocols and surveillance guidelines.METHODSThis study includes the PanCareSurFup and ProCardio cohort of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009 in seven European countries (N = 42,361). We calculated the cumulative incidence of HF and conducted a nested case-control study to evaluate detailed treatment-related risk factors.RESULTSThe cumulative incidence of HF was 2% (95% CI, 1.7 to 2.2) by age 50 years. The case-control study (n = 1,000) showed that survivors who received a mean heart radiation therapy (RT) dose of 5 to < 15 Gy have an increased risk of HF (odds ratio, 5.5; 95% CI, 2.5 to 12.3), when compared with no heart RT. The risk associated with doses 5 to < 15 Gy increased with exposure of a larger heart volume. In addition, the HF risk increased in a linear fashion with higher mean heart RT doses. Regarding total cumulative anthracycline dose, survivors who received ≥ 100 mg/m2 had a substantially increased risk of HF and survivors treated with a lower dose showed no significantly increased risk of HF. The dose-response relationship appeared quadratic with higher anthracycline doses.CONCLUSIONSurvivors who received a mean heart RT dose of ≥ 5 Gy have an increased risk of HF. The risk associated with RT increases with larger volumes exposed. Survivors treated with < 100 mg/m2 total cumulative anthracycline dose have no significantly increased risk of HF. These new findings might have consequences for new treatment protocols for children with cancer and for cardiomyopathy surveillance guidelines.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Oncology
volume
41
issue
1
pages
11 pages
publisher
American Society of Clinical Oncology
external identifiers
  • scopus:85144590239
  • pmid:36075007
ISSN
0732-183X
DOI
10.1200/JCO.21.02944
language
English
LU publication?
yes
id
72043cc0-b08e-493d-bbaa-b3aa62df471f
date added to LUP
2023-02-03 15:57:21
date last changed
2024-06-13 14:15:28
@article{72043cc0-b08e-493d-bbaa-b3aa62df471f,
  abstract     = {{<p>PURPOSE Heart failure (HF) is a potentially life-threatening complication of treatment for childhood cancer. We evaluated the risk and risk factors for HF in a large European study of long-term survivors. Little is known of the effects of low doses of treatment, which is needed to improve current treatment protocols and surveillance guidelines.METHODSThis study includes the PanCareSurFup and ProCardio cohort of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009 in seven European countries (N = 42,361). We calculated the cumulative incidence of HF and conducted a nested case-control study to evaluate detailed treatment-related risk factors.RESULTSThe cumulative incidence of HF was 2% (95% CI, 1.7 to 2.2) by age 50 years. The case-control study (n = 1,000) showed that survivors who received a mean heart radiation therapy (RT) dose of 5 to &lt; 15 Gy have an increased risk of HF (odds ratio, 5.5; 95% CI, 2.5 to 12.3), when compared with no heart RT. The risk associated with doses 5 to &lt; 15 Gy increased with exposure of a larger heart volume. In addition, the HF risk increased in a linear fashion with higher mean heart RT doses. Regarding total cumulative anthracycline dose, survivors who received ≥ 100 mg/m2 had a substantially increased risk of HF and survivors treated with a lower dose showed no significantly increased risk of HF. The dose-response relationship appeared quadratic with higher anthracycline doses.CONCLUSIONSurvivors who received a mean heart RT dose of ≥ 5 Gy have an increased risk of HF. The risk associated with RT increases with larger volumes exposed. Survivors treated with &lt; 100 mg/m2 total cumulative anthracycline dose have no significantly increased risk of HF. These new findings might have consequences for new treatment protocols for children with cancer and for cardiomyopathy surveillance guidelines.</p>}},
  author       = {{De Baat, Esmée C. and Feijen, Elizabeth A.M. and Reulen, Raoul C. and Allodji, Rodrigue S. and Bagnasco, Francesca and Bardi, Edit and Belle, Fabiën N. and Byrne, Julianne and Van Dalen, Elvira C. and Debiche, Ghazi and Diallo, Ibrahima and Grabow, Desiree and Hjorth, Lars and Jankovic, Momcilo and Kuehni, Claudia E. and Levitt, Gill and Llanas, Damien and Loonen, Jacqueline and Zaletel, Lorna Z. and Maule, Milena M. and Miligi, Lucia and Van Der Pal, Helena J.H. and Ronckers, Cécile M. and Sacerdote, Carlotta and Skinner, Roderick and Jakab, Zsuzsanna and Veres, Cristina and Haddy, Nadia and Winter, David L. and De Vathaire, Florent and Hawkins, Michael M. and Kremer, Leontien C.M.}},
  issn         = {{0732-183X}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{96--106}},
  publisher    = {{American Society of Clinical Oncology}},
  series       = {{Journal of Clinical Oncology}},
  title        = {{Risk Factors for Heart Failure among Pan-European Childhood Cancer Survivors : A PanCareSurFup and ProCardio Cohort and Nested Case-Control Study}},
  url          = {{http://dx.doi.org/10.1200/JCO.21.02944}},
  doi          = {{10.1200/JCO.21.02944}},
  volume       = {{41}},
  year         = {{2023}},
}