Patients with acute myeloid leukemia (AML) often receive a drug called daunorubicin. Daunorubicin is a type of drug called an anthracycline, which increases the risk of some damage to the heart. Beta blockers and angiotensin-converting enzyme inhibitors (ACEi) are two types of drugs that are often used (and are FDA approved) to treat the type of damage to the heart caused by anthracyclines. They have also been used in some populations to prevent this type of heart damage. In this study, participants will be randomly assigned to either preventively take a beta blocker and ACEi or not to receive these. The primary purpose of the study is to look at how often people in each group develop this type of heart damage. The study investigators will also collect data about your quality of life and other changes in your heart function. Frequency and severity of anthracycline-induced cardiotoxicity among patients receiving acute myeloid leukemia (AML) chemotherapy is unknown. We hypothesize that up-titrating study agents to maximum tolerated dosage at the time of induction (starting treatment for AML) will prevent the development of systolic dysfunction as determined on serial echocardiography.
Participants will know which group they are assigned to, and if someone in the group not receiving the preventive drugs needs these drugs for their clinical care, they will be able to receive them. Participants in both groups will receive the standard clinical care medicines and lab tests for their AML. Everyone will have electrocardiograms (also called ECGs or EKGs) and echocardiograms before and at multiple timepoints during the study. They will also have a special blood test to see their levels of troponin, a protein that helps with muscle contractions in your heart. All participants will complete questionnaires at a few timepoints during the study to measure their quality of life. Participants in the preventive beta blocker and ACEi group will take these drugs when they're in the hospital and at home, keeping a diary of when they take it when they're at home. The hypothesis of the study is that taking a beta blocker and ACEi during initial therapy for AML and through about 90 days after they last take an anthracycline will prevent the development of this heart problem.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
70
Preventive beta blocker (metoprolol or carvedilol) and an ACE inhibitor (lisinopril)
University of Virginia
Charlottesville, Virginia, United States
RECRUITINGLeft ventricular ejection fraction (LVEF)
As determined by echocardiogram
Time frame: Baseline through 90 days after first day of last cycle of anthracycline (usually up to 6 months later)
Congestive heart failure
As diagnosed by treating physician
Time frame: Baseline through 90 days after first day of last cycle of anthracycline (usually up to 6 months later)
Changes in quality of life
As measured by the FACT-Leu questionnaire
Time frame: Baseline through 90 days after first day of last cycle of anthracycline (usually up to 6 months later)
Global longitudinal strain
As measured by echocardiogram
Time frame: Baseline through 90 days after first day of last cycle of anthracycline (usually up to 6 months later)
Troponin levels
Frequency of elevation in troponin and average troponin
Time frame: Baseline through 90 days after first day of last cycle of anthracycline (usually up to 6 months later)
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