Death rate in acute leukemia is very low nowadays. Dilated cardiomyopathy due to anthracyclins remains a current cause of morbidity and mortality in mid-term and long-term follow-up of survivors. Classic therapies for chronic heart failure is not efficient in those cardiomyopathies. We studied children treated by anthracyclins with or without concomittant radiotherapy a few years ago, to define the profile of left ventricular alterations and the effect of steady physical activity.

We included patients treated between 2000 and 2018 by anthracyclins in Marseille and followed-up in the multicentric prospective cohort of adolescents and children leukemia. We quantified physical activity in MET hour per week before and after therapy for leukemia.

40 patients were inluded, aged from 5 to 25. All were treated by anthracyclins for acute leukemias. The mean cumulated dose of doxorubicin-equivalent was 191mg/m². Seven receaved total body irradiation of 12 Gray at the same time. 14 children were used to practice physical activity before leukemia and 36 patients after leukemia. We diagnosed 3 dilated cardiomyopathies and observed 10 longitudinal strain alterations. Radiotherapy and cumulated dose>240mg/m² were risk factors for developping strain alteration. The practice of physical activity more than 28 MET.h per week after the treatment of acute leukemia was an independant protective factor for developping longitudinal strain alteration (Fig. 1, Table 1).

Moderate steady physical activity seams to be a protective factor for developping longitudinal strain alteration is patients treated during childhood by anthracyclins. This a safe treatment, with pleitropic benefits and we determined a target of 28 MET.h per week to help oncologists for long-term follow-up of survivors of childhood acute leukemia.