Dexrazoxane Cardioprotection in pediatric ALL: a historical control cohort study

OBJECTIVE: This ambispective cohort study evaluates the effectiveness of cardioprotective strategies in reducing anthracycline-induced cardiotoxicity in pediatric patients with acute lymphoblastic leukemia (ALL). METHODS: We conducted a single-center, historically controlled ambispective cohort study at Kunming Children’s Hospital. Children with newly diagnosed ALL treated with the CCLG-ALL2018 protocol between May 2018 and May 2020 comprised the retrospective historical control cohort (no dexrazoxane). After institutional adoption of dexrazoxane, consecutive eligible patients treated between May 2020 and May 2022 were prospectively enrolled and followed according to a prespecified cardiac monitoring schedule. The exposure (use of dexrazoxane) was determined by calendar time rather than randomization. RESULTS: The combination therapy group exhibited significantly lower rates of electrocardiogram and echocardiogram abnormalities (P < 0.01 and P < 0.01, respectively), suggesting a notable cardioprotective effect. Although baseline cardiac markers did not show significant differences between the groups, post-treatment levels of cardiac troponin T were significantly improved in the combination therapy group (P < 0.05). Additionally, trends toward improved left ventricular ejection fraction and Creatine Kinase-Myocardial Band levels were observed, although these did not reach statistical significance. Importantly, the use of the cardioprotective agent did not lead to a significant increase in adverse reactions. CONCLUSION: Incorporating a cardioprotective strategy into pediatric ALL treatment protocols appears to lower the risk of anthracycline-induced cardiotoxicity without compromising safety, hence boosting patient outcomes. These findings should be interpreted in light of the historically controlled, nonrandomized design and potential time-related confounding.