Is there a link between acute myeloid leukemia and heart failure?

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Anthracyclines are a standard treatment for AML, and it is common for doctors to prescribe them. However, anthracyclines accumulate in the body, becoming toxic to cardiac cells and killing them, which causes permanent heart damage.

Research shows that anthracyclines seem to damage the heart in a way that reduces the amount of blood that the left ventricle pumps out to the body. It also suggests that it is the accumulation of free radicals from the metabolism of anthracyclines that is responsible for the destruction of heart cells. Specifically, the breakdown of anthracyclines produces hydrogen peroxide.

In a 2019 study involving 450 participants receiving anthracycline treatment for AML, 11.6% of the participants developed heart failure roughly 12 months after starting therapy.

Most people do not notice any symptoms of anthracycline toxicity until it has become more severe. When cardiotoxicity is low to moderate, a person’s heart usually returns to functioning normally once they stop taking anthracyclines.

Aside from anthracycline toxicity, a few other factors associated with AML may also cause heart damage that can lead to heart failure. These factors include:

• leukemia cells migrating to the heart and crowding out healthy heart cells or damaging the cells themselves
• so-called cytokine storms, which lead to high levels of molecules called cytokines that encourage inflammation
• reduced blood and oxygen flow to heart tissues (ischemia) due to anemia
• secondary cancers that develop after treatment

Leukemia is an umbrella term for cancers that develop in immature white blood cells. Usually, healthy white blood cells help prevent and fight infection.

Myeloid leukemias develop in immature white blood cells called myeloid cells. When leukemia affects lymphocytes instead, it is called lymphocytic leukemia.

AML is a type of myeloid leukemia that develops fairly suddenly and is often severe. In cases of AML, cells may also enter the bloodstream quickly, where they can travel to and affect other organs and tissues — in particular, the liver, spleen, testicles, brain, and spinal cord.

The symptoms of AML include:

• unexplained exhaustion
• loss of appetite
• fever
• unintentional weight loss
• night sweats
• weakness, sometimes on only one side of the body
• feeling cold
• headaches
• feeling lightheaded or dizzy
• pale skin
• breathlessness or trouble breathing
• unexplained or excessive bruising
• nosebleeds, bleeding gums, and heavy periods
• confusion and slurred speech
• unexplained or inappropriate sleepiness
• joint or bone pain
• abdominal swelling

Learn more about acute myeloid leukemia here.

As with other cancers, there is no guaranteed way to prevent AML.

However, smoking is the most significant controllable risk factor for developing the condition. Therefore, quitting smoking, if a smoker, or avoiding secondhand smoke exposure may reduce the risk of AML.

There is also some evidence that cancer-causing chemicals, such as the solvent benzene, may increase the risk of developing AML.

People who work in oil refineries, rubber factories, and chemical plants may be at higher risk of exposure to benzene. It is also present in:

• gasoline
• cigarette smoke
• some glues
• certain cleaning products
• some detergents
• certain paints
• exhaust from motor vehicles
• some art supplies

Research has also linked AML with formaldehyde exposure, although more studies are necessary to confirm this association. Therefore, avoiding exposure to benzene, formaldehyde, and other carcinogenic chemicals may reduce the risk of AML.

In some cases, AML may develop as a secondary type of cancer after someone undergoes radiation therapy or chemotherapy. Researchers are looking for new treatments for cancer that do not increase the likelihood of developing leukemia. At present, though, the benefits of treatment tend to outweigh the risks.

There are many ways to reduce the risk of developing heart failure or heart disease, most of which involve adopting certain lifestyle measures, such as:

• eating a nutritious, balanced diet
• getting enough fiber
• limiting the intake of saturated and trans fats
• drinking alcohol only in moderation
• reducing salt and sugar intake
• reaching and maintaining a moderate body weight
• exercising regularly
• refraining from smoking
• managing medical conditions that can affect the heart, such as blood pressure, high cholesterol, and diabetes

Treatment for AML needs to begin as soon as possible because the disease tends to progress quickly. People with heart failure and AML should receive treatment from a team of cardiologists and oncologists.

Learn more about heart-healthy foods here.

The outlook for a person with AML will depend on various factors, including age and the presence or absence of specific gene or chromosomal changes within the leukemia cells. Unlike with other incurable forms of leukemia, the goal of AML treatment is to return blood cell counts to normal levels and remove all signs of leukemia from the bone marrow.

About 2 in 3 people with AML who undergo standard chemotherapy enter remission, which is a period without symptoms or disease progression.

People below the age of 60 years generally have a better outlook than older people, who frequently have chromosomal changes in their leukemia cells. Older age can also make it harder for the body to tolerate treatments. However, an estimated 50% of people over the age of 60 years with AML go into remission after treatment.

Once someone with AML is in remission, they often continue to receive chemotherapy, known as consolidation therapy, to remove any potential lingering leukemia cells. About 50% of people who receive consolidation therapy enter long-term remission and might be cured.

People who receive a stem cell transplant as a form of consolidation therapy tend to have a higher success rate, but the procedure can cause fatal complications.

The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program provides data on 5-year relative survival rates for people with AML, which show the percentage of people likely to live at least 5 years after their diagnosis compared with the general public.

The 5-year survival rates for AML are:

• 27.6% overall
• 57.1% in people younger than 50 years
• 32.9% in people aged 50–64 years
• 7.5% in people aged 65 years and older

Acute myeloid leukemia can cause heart failure, most commonly because the medications that doctors use to treat it can cause permanent heart damage.

Less commonly, leukemia cells can travel to the heart and damage cells or reduce the number of cells that deliver blood and oxygen to the heart.

People with AML and heart failure require treatment from oncologists and cardiologists to extend their lives. The outlook for these individuals may be less positive than it is for people with just one of these conditions.