Early Cardiotoxicity in Pediatric Patients with Acute Lymphoblastic Leukemia and Hodgkin Lymphoma: Incidence, Risk Factors, and Clinical Implications

Background: Cardiotoxicity is a major adverse effect of antineoplastic therapy in pediatric oncology, potentially leading to long-term morbidity. This study aimed to evaluate the incidence, spectrum, and risk factors of early cardiovascular (CV) complications in children treated for acute lymphoblastic leukemia (ALL) and Hodgkin lymphoma (HL). Methods: In this retrospective cohort study, 109 patients diagnosed with ALL or HL between 2013 and 2019 were analyzed. All patients were under 18 years at diagnosis. CV assessment included electrocardiography, echocardiography, blood pressure and Holter monitoring, and additional imaging where available. Early cardiotoxicity was defined as CV events occurring during or shortly after therapy, including echocardiographic abnormalities, arrhythmias, arterial hypertension, and other CV complications. Descriptive and exploratory statistical analyses were performed to identify potential risk factors. Results: Early CV events occurred in 69% of ALL patients and 68% of HL patients. Multiple CV events were observed in 32% of ALL and 36% of HL patients. Most cardiotoxic effects were subclinical or transient; clinically significant CV complications were rarely detected. These comprised treatment-requiring heart failure, arterial hypertension, and thromboembolic events. Persistent CV abnormalities were also observed, including subclinical cardiac dysfunction, arterial hypertension, and cardiac arrhythmias. The majority of CV complications occurred within the first 500 days after therapy initiation. Increased cardiotoxicity was associated with older age, higher treatment risk groups, and disease relapse, while no significant sex differences were identified. Conclusions: CV abnormalities were frequent in children and adolescents receiving treatment for ALL or HL, although most were subclinical or transient. Clinically significant CV complications were uncommon. These findings support systematic CV surveillance during and after pediatric cancer therapy, with particular attention to persistent abnormalities and potentially treatable complications.