We assessed the financial cost of inappropriate NGS testing from five UK hospital haematology departments over a two-year period. NGS testing can be requested inappropriately for several reasons such as having no impact on clinical management and those receiving unnecessary repeat tests without disease progression. NGS is generally indicated in patients under the age of 70 with blood cancers including AML, Myelodysplastic Syndrome (MDS), MF, CMML and Myeloproliferative Neoplasms (MPN). The European Leukaemia Network (ELN) has incorporated molecular abnormalities to risk stratify Acute Myeloid Leukaemia (AML) and various risk scores in Myelofibrosis (MF) and Chronic Myelomonocytic Leukaemia (CMML) also incorporate molecular mutations. It has become an important diagnostic tool alongside the bone marrow biopsy and karyotype. Sebastian Francis 1, Ferkhanda Zareen 1,*, Catherine Turner 1, Jack Neeson 1ġHaematology, Sheffield Teaching Hospitals NHS Foundation Trust, SHEFFIELD, United KingdomĪbstract Content: Next generation sequencing (NGS) myeloid panels have revolutionised the diagnosis of myeloid malignancies. Age-stratified impact of anthracycline chemotherapy on cardiac function at different stages in AML treatment.ĭisclosure of Interest: None Declared BSH2021-PO-034 A regional experience of NGS Myeloid panels in Myeloid Haematological malignancies Our data highlights the significant impact that anthracycline-induced cardiac toxicity can have on paediatric AML patients, particularly those aged under 4 years, and the promising benefit that dexrazoxane may have in addressing this longstanding problem. Out of the 5 patients who received dexrazoxane prior to their anthracycline therapy, no deterioration in cardiac function was observed, and all these patients count recovered prior to their day 35 bone marrow assessments.
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4 of these patients are under long-term cardiology follow up and the remaining patient died of transplant complications. 6 patients (16%) experienced a significant reduction in cardiac function secondary to anthracycline chemotherapy, with 1 patient now on a palliative pathway due to dilated cardiomyopathy despite her AML being in remission. Mean left ventricular ejection fraction (LVEF) prior to 1 st course of treatment was 67% (65% in those aged over 4 years and 69% in the younger cohort), decreasing to 61% post 1 st course anthracycline-containing treatment and 59% at the end of treatment (see table 1). 3 patients had relapsed disease, the remaining 35 were primary presentations and 17 patients were aged under 4 years, with 5 patients having Down Syndrome. The patient cohort was obtained from the departmental database and clinical information and echo reports were obtained from hospital online record systems, PEPR and HeartSuite.Ĥ0 patients received a diagnosis of AML at BCH over the 5-year study period, 2 patients were excluded as they died prior to treatment, leaving 38 patients for analysis with a mean age of 6 years 10 months.
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Our aim was to assess the frequency of anthracycline-induced cardiotoxicity in the paediatric AML population, the effect of age, and the impact that dexrazoxane has had since its routine incorporation into anthracycline-containing treatment protocols. We conducted a retrospective analysis of all patients who had been diagnosed with AML at Birmingham Children’s Hospital (BCH), a large paediatric tertiary centre, over a 5-year period between January 2016 and January 2021. Subsequent analysis has resulted in its acceptance as a cardioprotective agent in the treatment of paediatric malignancies.
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Dexrazoxane has been shown as an efficacious agent in the prevention of anthracycline-induced cardiotoxicity, however, in 2011 its use in the paediatric population was contraindicated by the EMA due to lack of efficacy in this cohort and concerns about its side effect profile. Despite this, data regarding the frequency of cardiotoxicity amongst this population is rare in the United Kingdom and various risk factors have been associated, including age less than 4 years. ALL, AML, MDS & bone marrow failure BSH2021-PO-033 Anthracycline-induced cardiomyopathy in paediatric acute myeloid leukaemia-A single centre age-stratified retrospective analysis and the early impact of dexrazoxaneĬlaire Horgan 1,*, Yashashree Gupta 1, Jayashree Motwani 1ġHaematology, Birmingham Children’s Hospital, Birmingham, United KingdomĪbstract Content: As survival rates for paediatric acute myeloid leukaemia (AML) have improved over recent decades, the risk of anthracycline-induced cardiomyopathy has become an increasing concern for the treating clinician and can have detrimental effects on the quality of life of survivors.