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Combined enalapril, carvedilol may benefit patients with malignant hemopathies
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Combined treatment with enalapril and carvedilol may prevent chemotherapy-induced left ventricular systolic dysfunction in patients with hematological malignancies, according to findings from the OVERCOME trial.
The randomized controlled study included 36 patients without left ventricular systolic dysfunction (LVSD) with a recent diagnosis of acute leukemia and 54 patients with malignant hemopathies who were undergoing autologous hematopoietic stem cell transplantation. Half of the patients were randomly assigned enalapril and carvedilol and half were assigned to a control group at least 24 hours before the first cycle of chemotherapy. Echocardiographic and cardiac magnetic resonance (CMR) imaging were performed before randomization and at 6 months.
The primary endpoint was absolute change from baseline in LV ejection fraction. At 6 months, the researchers found no change in LVEF in the enalapril/carvedilol group and a significant decrease in the control group. The absolute difference was –3.1% by echocardiography (P=.035) and –3.4% (P=.09) by CMR (n=59 patients). The corresponding absolute difference in LVEF was –1% in patients undergoing autologous hematopoietic stem cell transplantation and –6.38% in patients with acute leukemia (P=.08 for interaction).
Patients assigned enalapril/carvedilol had a lower incidence of death/HF (6.7% vs. 22%; P=.036) and death/HF/final LVEF <45% (6.7% vs. 24.4%; P=.02) compared with patients in the control group.
“The OVERCOME study has shown that concomitant treatment with enalapril and carvedilol may prevent LVSD in patients with malignant hemopathies treated with high-dose chemotherapy regimens,” the researchers wrote. “The results were consistent as measured with two-dimensional echocardiography or CMR, although the lower number of patients studied with the latter method precluded obtaining a conventional significant statistical difference.
“The clinical relevance of this strategy should be confirmed in larger studies,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.
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