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Preserving Cardiac Function With Dexrazoxane in Pediatric Patients With AML

By: Sarah Campen, PharmD
Posted: Friday, June 5, 2020

In pediatric patients with acute myeloid leukemia (AML) treated with anthracyclines, dexrazoxane may preserve cardiac function without compromising event-free and overall survival or increasing noncardiac toxicities, according to a multicenter study published in the Journal of Clinical Oncology. Richard Aplenc, MD, MSCE, of the Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, and colleagues observed that dexrazoxane-exposed patients had significantly smaller declines in ejection fraction and shortening fraction than unexposed patients.

“Dexrazoxane use should be considered during front-line treatment for pediatric acute myeloid leukemia to mitigate short-term anthracycline-associated cardiac dysfunction,” stated the authors.

The study included 1,014 pediatric patients with AML from the AAML1031 trial, a prospective Children’s Oncology Group study that enrolled patients from 2011 to 2016. Dexrazoxane was administered at the discretion of treating physicians; in all, 96 patients received dexrazoxane consistently at every anthracycline course, and the remaining 918 patients were never exposed to the cardioprotective agent.

Dexrazoxane use prior to anthracycline courses significantly decreased the rate of left ventricular systolic dysfunction compared with patients without dexrazoxane exposure (26.5% vs. 42.2%, P = .009) and reduced grade 2 or higher left ventricular systolic dysfunction by 60%.

Dexrazoxane-exposed patients had similar 5-year event-free and overall survival compared with dexrazoxane-unexposed patients. However, the addition of dexrazoxane resulted in lower treatment-related mortality (5.7% vs. 12.7%; P = .068).

“Efforts should be made to acquire additional follow-up on cardiac outcomes to fully assess the long-term impacts of dexrazoxane use,” the authors concluded.

Disclosure: For full disclosures of the study authors, visit

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