Efficacy and Safety of Levosimendan in Severe Cardiac Dysfunction in Children Undergoing Cancer Chemotherapy and Hematopoietic Stem Cell Transplantation

Cancer Therapy Related Cardiac Dysfunction is a significant challenge in the field of pediatric hemato-oncology and is often under-recognized. The study reports the role of levosimendan as a cardio-protective agent in pediatric onco-critical care. A retrospective study was performed in children up to 18 years of age undergoing chemotherapy for malignant disorders and those undergoing hematopoietic stem cell transplantation (HSCT) from January 2020 to December 2023. The primary objective was to assess the efficacy and safety of levosimendan in pediatric hemato-oncology and HSCT patients with severe cardiac dysfunction. The secondary objective was to study the effectiveness of levosimendan as both first- and second-line cardiac support drug. We administered levosimendan as a first line agent in children with known cardiac dysfunction and second line in children with shock with cardiac dysfunction after other short-acting inotropes. The study included 62 children with 85% overall response rate and a mean improvement in ejection fraction from 50 to 58%. The mean Vasoactive-Inotropic Score (VIS) reduction was 3.2. A follow up ECHO after four weeks demonstrated normal heart function in all children. Levosimendan is a safe and effective agent in the treatment of acute heart failure in hemato-oncology patients who maintain normal or high blood pressure. The results have helped tailor supportive critical care in pediatric hemto-oncology patients with cardiac dysfunction.