Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods and Patients
2.1. Study Design and Population
2.2. Study Objectives and Variables
2.3. Definitions
2.4. Statistical Analyses
3. Results
3.1. Patient Disposition and AML Characteristics
3.2. Fatal Cardiac Events in the Overall Cohort
3.3. Non-Fatal Cardiac Events in the Overall Cohort
3.4. Timing of Cardiac Events
3.5. Cardiac Events in Intensive Versus Non-Intensive Front-Line Cohorts
3.6. QTc Prolongation Events in the Overall Cohort
3.7. Arrhythmia Events in the Overall Cohort
3.8. Heart Failure and Myocardial Ischemic Events in the Overall Cohort
3.9. Clinical Outcomes after Intensive Approaches According to the Development of Cardiac Events
3.10. Cardiac Events in the 1L Cohort
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Therapeutic Approach | Schedule | Number of Patients n = 571 (%) |
---|---|---|
Intensive chemotherapy | 218 (38) | |
IDA 1 + Ara-C 2 (3 + 7) | 195 (34) | |
IDA + Ara-C (2 + 5) | 3 (1) | |
FLAG-IDA (fludarabine + Ara-C + IDA) | 10 (2) | |
IDA + Ara-C (3 + 7) + midostaurin | 4 (1) | |
Allogeneic transplant | 4 (1) | |
Other intensive chemotherapy | 2 (0.3) | |
Non-intensive therapy | 75 (13) | |
Azacitidine | 6 (1) | |
Decitabine | 1 (0.2) | |
FLUGA (fludarabine + LD-Ara-C) | 68 (12) | |
Clinical Trial | 232 (41) | |
Intensive | 67 (12) | |
Intensive + FLT3 inhibitor/ placebo | 31 (5) | |
Intensive without FLT3 inhibitor | 36 (6) | |
Non-intensive | 165 (29) | |
Non-intensive + FLT3 inhibitor | 1 (0.2) | |
Non-intensive without FLT3 inhibitor | 164 (29) | |
Supportive care only | 46 (8) |
Characteristic | Overall | Relevant Cardiac Comorbidities | No Cardiac Comorbidities | p | |||
---|---|---|---|---|---|---|---|
Median (Range) | n (%) | Median (Range) | n (%) | Median (Range) | n (%) | ||
N | 571 (100) | 82 (14) | 489 (86) | ||||
Age, years | 65 (18–98) | 72 (37–98) | 64 (18–92) | <0.001 * | |||
<65 | 272 (48) | 25 (30) | 247 (51) | 0.001 | |||
≥65 | 299 (52) | 57 (70) | 242 (49) | ||||
Gender | 571 | 82 | 489 | ||||
Male | 331 (58) | 60 (73) | 271 (55) | 0.004 | |||
Female | 240 (42) | 22 (27) | 218 (45) | ||||
ECOG | 1 (0–4) | 571 | 1 (0–4) | 82 | 1 (0–4) | 489 | 0.001 * |
0–1 | 432 (76) | 54 (66) | 378 (77) | 0.04 | |||
≥2 | 139 (24) | 28 (34) | 111 (23) | ||||
Comorbidities | 571 | 82 | 489 | ||||
Yes | 379 (66) | 75 (91) | 304 (62) | <0.001 | |||
No | 192 (34) | 7 (9) | 185 (38) | ||||
Type of AML | 571 | 82 | 489 | ||||
De novo | 350 (61) | 45 (55) | 305 (62) | 0.298 | |||
Therapy-related | 91 (16) | 13 (16) | 78 (16) | ||||
Previous MDS/MPN | 130 (23) | 24 (29) | 106 (22) | ||||
WHO classification | 571 | 82 | 489 | ||||
AML-RGA | 154 (27) | 20 (24) | 134 (27) | 0.819 | |||
AML-NOS | 68 (12) | 10 (12) | 58 (12) | ||||
AML-MRC | 240 (42) | 41 (50) | 199 (41) | ||||
t-AML | 52 (9) | 5 (6) | 47 (10) | ||||
Myeloid sarcoma | 2 (0.4) | 0 | 2 (0.4) | ||||
Ambiguous lineage | 8 (1) | 1 (1) | 7 (1) | ||||
BPDCN | 2 (0.4) | 0 | 2 (0.4) | ||||
Not available | 45 (8) | 5 (6) | 40 (8) | ||||
Extramedullary disease | 569 | 82 | 487 | ||||
Yes | 100 (18) | 14 (17) | 86 (18) | 0.978 | |||
No | 469 (82) | 68 (83) | 401 (82) | ||||
WBC, ×109/L | 8 (0.3–434.3) | 571 | 8.2 (0.3–300.2) | 82 | 8 (0.3–434.3) | 489 | 0.640 * |
≤5 | 241 (42) | 35 (43) | 206 (42) | 0.705 | |||
5–10 | 68 (12) | 11 (13) | 57 (12) | ||||
10–50 | 153 (27) | 24 (29) | 129 (26) | ||||
> 50 | 109 (19) | 12 (15) | 97 (20) | ||||
Hemoglobin, g/dL | 8.8 (2.9–15.5) | 571 | 8.4 (5–12.9) | 82 | 8.8 (2.9–15.5) | 489 | 0.078 * |
≤10 | 434 (76) | 70 (85) | 364 (74) | 0.044 | |||
>10 | 137 (24) | 12 (15) | 125 (26) | ||||
Platelet count, ×109/L | 53 (1–1442) | 570 | 47 (8–816) | 81 | 54 (1–1442) | 489 | 0.275 * |
≤20 | 109 (19) | 16 (20) | 93 (19) | 0.997 | |||
> 20 | 461 (81) | 65 (80) | 396 (81) | ||||
PB blasts, % | 563 | 82 | 481 | ||||
≤50 | 417 (74) | 64 (78) | 353 (73) | 0.451 | |||
> 50 | 146 (26) | 18 (22) | 128 (27) | ||||
BM blasts, % | 47 (0–100) | 559 | 43 (14–100) | 81 | 48 (0–100) | 478 | 0.239 * |
≤30 | 158 (28) | 28 (35) | 130 (27) | 0.339 | |||
>30≤70 | 234 (42) | 29 (36) | 205 (43) | ||||
>70 | 167 (30) | 24 (30) | 143 (30) | ||||
Creatinine, mg/dL | 0.9 (0.1–7.4) | 570 | 1 (0.2–5.4) | 82 | 0.8 (0.1–7.4) | 488 | <0.001 * |
≤1.3 | 482 (85) | 58 (71) | 424 (87) | <0.001 | |||
> 1.3 | 88 (15) | 24 (29) | 64 (13) | ||||
Urea, mg/dL | 36 (6–174) | 554 | 45 (18–158) | 81 | 35 (6–174) | 473 | <0.001 * |
≤50 | 429 (77) | 46 (57) | 383 (81) | <0.001 | |||
>50 | 125 (23) | 35 (43) | 90 (19) | ||||
Uric acid, mg/dL | 5 (1–29) | 489 | 5.8 (1.4–17.1) | 68 | 4.9 (1–29) | 421 | 0.002 * |
≤7 | 398 (81) | 48 (71) | 350 (83) | 0.022 | |||
>7 | 91 (19) | 20 (29) | 71 (17) | ||||
Bilirubin, mg/dL | 0.6 (0.1–6.2) | 553 | 0.7 (0.1–2.3) | 77 | 0.6 (0.1–6.2) | 472 | 0.313 * |
≤1.2 | 484 (88) | 68 (86) | 416 (88) | 0.813 | |||
>1.2 | 69 (12) | 11 (14) | 58 (12) | ||||
AST, U/L | 22 (6–1085) | 549 | 22 (7–185) | 77 | 22 (6–1085) | 472 | 0.061 * |
≤50 | 482 (88) | 69 (90) | 413 (88) | 0.821 | |||
>50 | 66 (12) | 8 (10) | 58 (12) | ||||
ALT, U/L | 18 (3–714) | 566 | 16 (3–125) | 80 | 19 (3–714) | 486 | 0.68 * |
≤50 | 504 (89) | 75 (94) | 429 (88) | 0.207 | |||
>50 | 62 (11) | 5 (6) | 57 (12) | ||||
Albumin, g/dL | 3.7 (1.6–5.2) | 518 | 3.7 (2.2–4.8) | 69 | 3.7 (1.6–5.2) | 449 | 0.148 * |
≤3.5 | 204 (39) | 31 (45) | 173 (39) | 0.379 | |||
>3.5 | 314 (61) | 38 (55) | 276 (61) | ||||
LDH, U/L | 521 (101–42630) | 558 | 627 (149–11800) | 509 (101–42630) | 0.984 * | ||
≤600 | 307 (55) | 38 (48) | 269 (56) | 0.181 | |||
>600 | 251 (45) | 42 (53) | 209 (44) | ||||
Fibrinogen | 487 (34–1150) | 548 | 493 (162–1002) | 79 | 487 (34–1150) | 469 | 0.947 * |
≤170 | 6 (1) | 1 (1) | 5 (1) | 0.67 | |||
>170 | 542 (99) | 78 (99) | 464 (99) | ||||
Prothrombin time | 501 | 70 | 431 | ||||
Prolonged | 175 (35) | 33 (47) | 142 (33) | 0.03 | |||
Normal | 326 (65) | 37 (53) | 289 (67) | ||||
APTT | 541 | 76 | 465 | ||||
Prolonged | 73 (13) | 10 (13) | 63 (14) | 0.917 | |||
Normal | 468 (87) | 66 (87) | 401 (86) | ||||
Cytogenetics | 571 | 82 | 489 | ||||
Normal | 211 (37) | 34 (41) | 177 (36) | 0.8 | |||
Abnormal | 293 (51) | 38 (46) | 255 (52) | ||||
No metaphases | 47 (8) | 7 (9) | 40 (8) | ||||
Not available | 20 (4) | 3 (4) | 17 (3) | ||||
MRC Cytogenetic risk | 517 | 74 | 443 | ||||
Favorable | 27 (5) | 1 (1) | 26 (6) | 0.185 | |||
Intermediate | 307 (59) | 49 (66) | 258 (58) | ||||
Adverse | 183 (35) | 24 (32) | 159 (36) | ||||
FLT3-ITD | 517 | 77 | 440 | ||||
Positive | 79 (15) | 9 (12) | 70 (16) | 0.437 | |||
Negative | 438 (85) | 68 (88) | 370 (84) | ||||
FLT3-ITD ratio | 517 | 77 | 440 | ||||
<0.05 | 452 (87) | 70 (91) | 382 (87) | 0.752 | |||
0.05–0.5 | 24 (5) | 2 (3) | 22 (5) | ||||
0.5–0.8 | 23 (4) | 3 (4) | 20 (5) | ||||
≥0.8 | 18 (3) | 2 (3) | 16 (4) | ||||
FLT3-TKD | 505 | 75 | 430 | ||||
Positive | 26 (13) | 6 (8) | 20 (5) | 0.217 | |||
Negative | 479 (93) | 69 (92) | 410 (93) | ||||
NPM1 | 514 | 77 | 437 | ||||
Positive | 119 (23) | 18 (23) | 101 (23) | 0.924 | |||
Negative | 395 (77) | 59 (77) | 336 (77) | ||||
CEBPA | 571 | 82 | 489 | ||||
Positive | 14 (2) | 2 (2) | 12 (2) | 0.427 | |||
Negative | 317 (56) | 47 (57) | 270 (55) | ||||
Not available | 240 (42) | 33 (40) | 207 (42) | ||||
IDH | 571 | 82 | 489 | ||||
IDH1 positive | 23 (4) | 3 (4) | 20 (4) | 0.67 | |||
IDH2 positive | 54 (9) | 6 (7) | 48 (10) | ||||
Negative | 266 (47) | 43 (52) | 223 (46) | ||||
Not available | 228 (40) | 30 (37) | 198 (40) | ||||
Therapeutic approach | 571 | 82 | 489 | ||||
Intensive | 218 (38) | 19 (23) | 199 (41) | 0.043 | |||
HMA | 7 (1) | 2 (2) | 5 (1) | ||||
LDAC-based | 68 (12) | 11 (13) | 57 (12) | ||||
Clinical trial, intensive | 67 (12) | 9 (11) | 58 (12) | ||||
Clinical trial, non-intensive | 165 (29) | 32 (39) | 133 (27) | ||||
BSC | 46 (8) | 9 (11) | 37 (8) |
No Cardiac event | p-Value * | Fatal Cardiac Event | Non-Fatal Cardiac Event | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Characteristic | N (%) | Crude incidence N (%) | Cumulative Incidence | Crude incidence N (%) | Cumulative Incidence | |||||
At 6 months, % | At Last FU, % | p | At 6 months, % | At Last FU, % | p | |||||
N | 218 (42) | 19 * (3.6) | 2 | 6.7 | 288 (54.9) | 43.7 | 56.9 | |||
Age, N | 218 | 19 | 288 | |||||||
<65 years | 128 (48.5) | 0.005 | 9 (3.4) | 1.6 | 5.9 | 0.25 | 127 (48.1) | 37.8 | 49.9 | <0.001 |
≥65 years | 90 (34.5) | 10 (3.8) | 2.5 | 6.8 | 161 (61.7) | 49.7 | 64.4 | |||
Relevant cardiologic antecedents | 218 | 19 | 288 | |||||||
No | 202 (44.7) | <0.001 | 10 (2.2) | 1.2 | 4.9 | <0.001 | 240 (53.1) | 41.8 | 54.6 | 0.004 |
Yes | 16 (21.9) | 9 (12.3) | 7.2 | 20.1 | 48 (65.8) | 56.4 | 73 | |||
All cardiologic antecedents | 218 | 19 | 288 | |||||||
No | 163 (49.7) | <0.001 | 6 (1.8) | 0.7 | 4.1 | 0.0004 | 159 (48.5) | 37.6 | 49.7 | <0.001 |
Yes | 55 (27.9) | 13 (6.6) | 4.4 | 10.7 | 129 (65.5) | 54.2 | 70.6 | |||
Previous anthracycline treatment | 218 | 19 | 288 | |||||||
No | 207 (42.1) | 0.51 | 17 (3.5) | 1.7 | 6.5 | 0.22 | 268 (54.5) | 43.3 | 56.3 | 0.49 |
Yes | 11 (33.3) | 2 (6.1) | 6.7 | 6.7 | 20 (60.6) | 50.5 | 60.7 | |||
ECOG at diagnosis | 218 | 19 | 288 | |||||||
<2 | 173 (41.4) | 0.99 | 15 (3.6) | 2 | 6.7 | 0.56 | 230 (55) | 43.3 | 57.2 | 0.63 |
≥2 | 45 (42.1) | 4 (3.7) | 1.9 | 5.5 | 58 (54.2) | 45.5 | 56.1 | |||
FLT3-ITD status | 197 | 19 | 269 | |||||||
Negative | 161 (39.5) | 0.44 | 17 (4.2) | 2.3 | 7.8 | 0.53 | 230 (56.4) | 44.2 | 58.8 | 0.52 |
Positive | 36 (46.8) | 2 (2.6) | 1.4 | 3.1 | 39 (50.7) | 43.1 | 51.3 | |||
Treatment approach | 218 | 19 | 288 | |||||||
Intensive | 125 (43.9) | 0.5 | 10 (3.5) | 1.9 | 6.3 | 0.37 | 150 (52.6) | 42.5 | 54.7 | 0.17 |
Non-intensive | 93 (38.8) | 9 (3.8) | 2.2 | 6.8 | 138 (57.5) | 45.2 | 59.6 | |||
Inclusion in clinical trial | 218 | 19 | 288 | |||||||
No | 140 (47.8) | 0.004 | 8 (2.7) | 1.1 | 5.4 | 0.06 | 145 (49.5) | 37.4 | 50.8 | <0.001 |
Yes | 78 (33.6) | 11 (4.7) | 3.2 | 6.5 | 143 (61.6) | 51.8 | 65.2 | |||
Use of FLT3 inhibitors | 218 | 19 | 288 | |||||||
No | 204 (41.9) | 0.75 | 18 (3.7) | 2.2 | 4.8 | 0.76 | 265 (54.4) | 42.8 | 56.3 | 0.28 |
Yes | 14 (36.8) | 1 (2.6) | 0 | 3.1 | 23 (60.5) | 55.3 | 60.7 |
No Cardiac Event | p-Value * | Non-Life-Threatening | Life-Threatening | Fatal | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Characteristic | N (%) | Crude Incidence N (%) | Cumulative Incidence | Crude Incidence N (%) | Cumulative Incidence | Crude Incidence N (%) | Cumulative Incidence | |||||||
At 6 months, % | At Last FU, % | p | At 6 months, % | At Last FU, % | p | At 6 months, % | At Last FU, % | p | ||||||
N | 218 (41.5) | 261 (49.7) | 40 | 53.1 | 27 (5.1) | 4.1 | 6.4 | 19 (3.6) | 2 | 6.7 | ||||
Age | 218 | 261 | 27 | 19 | ||||||||||
<65 years | 128 (48.5) | <0.001 | 108 (40.9) | 32.9 | 43.8 | <0.001 | 19 (7.2) | 4.7 | 8.2 | 0.11 | 9 (3.4) | 1.6 | 5.9 | 0.25 |
≥65 years | 90 (34.5) | 153 (58.6) | 47.2 | 62.9 | 8 (3.1) | 3.5 | 3.5 | 10 (3.8) | 2.5 | 6.8 | ||||
Relevant cardiologic antecedents | 218 | 261 | 27 | 19 | ||||||||||
No | 202 (44.7) | <0.001 | 215 (47.6) | 37.9 | 50.4 | 0.001 | 25 (5.5) | 4.4 | 6.6 | 0.45 | 10 (2.2) | 1.2 | 4.9 | <0.001 |
Yes | 16 (21.9) | 46 (63) | 53.4 | 71.7 | 2 (2.7) | 1.9 | 4 | 9 (12.3) | 7.2 | 20.1 | ||||
Previous anthracycline treatment | 218 | 261 | 27 | 19 | ||||||||||
No | 207 (42.1) | 0.6 | 242 (49.2) | 39.5 | 52.3 | 0.33 | 26 (5.3) | 4.1 | 6.5 | 0.7 | 17 (3.5) | 1.7 | 6.5 | 0.22 |
Yes | 11 (33.3) | 19 (57.6) | 47.5 | 58.8 | 1 (3) | 4 | 4 | 2 (6.1) | 6.7 | 6.7 | ||||
ECOG at diagnosis | 218 | 261 | 27 | 19 | ||||||||||
<2 | 173 (41.4) | 0.99 | 209 (50) | 39.6 | 53.3 | 0.6 | 21 (5) | 3.8 | 6.1 | 0.56 | 15 (3.6) | 2 | 6.7 | 0.56 |
≥2 | 45 (42.1) | 52 (48.6) | 41.3 | 52.6 | 6 (5.6) | 5.5 | 7.5 | 4 (3.7) | 1.9 | 5.5 | ||||
FLT3-ITD status | 197 | 243 | 26 | 19 | ||||||||||
Negative | 161 (39.5) | 0.55 | 209 (51.2) | 40.3 | 55.3 | 0.34 | 21 (5.2) | 4.2 | 6.1 | 0.63 | 17 (4.2) | 2.3 | 7.8 | 0.53 |
Positive | 36 (46.8) | 34 (44.2) | 38.2 | 45.5 | 5 (6.5) | 5.6 | 7.3 | 2 (2.6) | 1.4 | 3.1 | ||||
Treatment chemotherapy | 218 | 261 | 27 | 19 | ||||||||||
Intensive | 125 (43.9) | 0.07 | 130 (45.6) | 37.6 | 48.8 | 0.025 | 20 (7) | 4.8 | 8.3 | 0.088 | 10 (3.5) | 1.9 | 6.3 | 0.37 |
Non-intensive | 93 (38.8) | 131 (54.6) | 42.7 | 58.1 | 7 (2.9) | 3.2 | 3.2 | 9 (3.8) | 2.2 | 6.8 | ||||
Inclusion in clinical trial | 218 | 261 | 27 | 19 | ||||||||||
No | 140 (47.8) | <0.001 | 125 (42.7) | 32.8 | 45.4 | <0.001 | 20 (6.8) | 5 | 8 | 0.096 | 8 (2.7) | 1.1 | 5.4 | 0.06 |
Yes | 78 (33.6) | 136 (58.6) | 49.2 | 63.5 | 7 (3) | 2.9 | 3.5 | 11 (4.7) | 3.2 | 6.5 | ||||
Use of FLT3 inhibitors | 218 | 0.71 | 261 | 27 | 19 | |||||||||
No | 204 (41.9) | 239 (49.1) | 38.9 | 52.3 | 0.19 | 26 (5.3) | 4.2 | 6.7 | 0.43 | 18 (3.7) | 2.2 | 4.8 | 0.76 | |
Yes | 14 (36.8) | 22 (57.9) | 53 | 58.8 | 1 (2.6) | 2.7 | 2.7 | 1 (2.6) | 0 | 3.1 |
All Patients | Cardiac Event | No Cardiac Event | p | |||
---|---|---|---|---|---|---|
Grades 1–2 | Grades 3–4 | Grade 5 | ||||
N (%) | N (%) | N (%) | N (%) | N (%) | ||
Response, n (%) | 285 (100) | 52 (100) | 98 (100) | 10 (100) | 125 (100) | |
ORR (CR + CRi) | 193 (67.7) | 39 (75) | 62 (63.3) | 8 (80) | 84 (67.2) | 0.426 |
CR | 184 (64.6) | 35 (67.3) | 58 (59.2) | 7 (70) | 84 (67.2) | |
CRi | 9 (3.1) | 4 (7.7) | 4 (4.1) | 1 (10) | 0 (0) | |
PR | 12 (4.2) | 1 (1.9) | 4 (4.1) | 0 (0) | 7 (5.6) | |
Resistance | 50 (17.5) | 10 (19.2) | 19 (19.4) | 1 (10) | 20 (16) | |
Induction death | 30 (10.5) | 2 (3.8) | 13 (13.3) | 1 (10) | 14 (11.2) | |
OS, n (%) | ||||||
Median (CI95), months | 21.6 (15.5–37.5) | 43.2 (21.6-NA) | 14.8 (13–21.5) | 5.2 (2.8-NA) | 34.2 (18-NA) | <0.001 |
1 year (CI95), % | 63 (57–68) | 73 (62–86) | 59 (50–70) | 30 (12–77) | 64 (56–73) | |
2 years (CI95), % | 48 (42–54) | 59 (47–74) | 38 (29–49) | 20 (6–69) | 64 (46–64) | |
3 years (CI95), % | 44 (39–50) | 57 (44–72) | 34 (25–45) | 20 (6–69) | 50 (42–60) | |
5 years (CI95), % | 39 (34–46) | 48 (35–65) | 30 (22–42) | 10 (2–64) | 47 (39–57) | |
EFS, n (%) | ||||||
Median (CI95), months | 10.2 (6.4–13) | 13.9 (5.5-NA) | 7.5 (4.1–12.6) | 3.5 (2.8-NA) | 12.3 (5.7–48) | 0.015 |
1 year (CI95), % | 46 (41–52) | 50 (38–66) | 42 (33–53) | 20 (6–69) | 50 (42–60) | |
2 years (CI95), % | 36 (31–42) | 48 (36–64) | 24 (17–35) | 20 (6–69) | 42 (35–52) | |
3 years (CI95), % | 34 (29–40) | 43 (32–60) | 23 (16–33) | 10 (2–64) | 41 (34–51) | |
5 years (CI95), % | 32 (26–38) | 40 (29–57) | 23 (16–33) | 10 (2–64) | 38 (30–48) |
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Boluda, B.; Solana-Altabella, A.; Cano, I.; Martínez-Cuadrón, D.; Acuña-Cruz, E.; Torres-Miñana, L.; Rodríguez-Veiga, R.; Navarro-Vicente, I.; Martínez-Campuzano, D.; García-Ruiz, R.; et al. Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia. Cancers 2023, 15, 2267. https://doi.org/10.3390/cancers15082267
Boluda B, Solana-Altabella A, Cano I, Martínez-Cuadrón D, Acuña-Cruz E, Torres-Miñana L, Rodríguez-Veiga R, Navarro-Vicente I, Martínez-Campuzano D, García-Ruiz R, et al. Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia. Cancers. 2023; 15(8):2267. https://doi.org/10.3390/cancers15082267
Chicago/Turabian StyleBoluda, Blanca, Antonio Solana-Altabella, Isabel Cano, David Martínez-Cuadrón, Evelyn Acuña-Cruz, Laura Torres-Miñana, Rebeca Rodríguez-Veiga, Irene Navarro-Vicente, David Martínez-Campuzano, Raquel García-Ruiz, and et al. 2023. "Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia" Cancers 15, no. 8: 2267. https://doi.org/10.3390/cancers15082267