Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer from the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Survivors of childhood, adolescent, and young adult cancer, previously treated with anthracycline chemotherapy (including mitoxantrone) or radiotherapy in which the heart was exposed, are at increased risk of cardiomyopathy. Symptomatic cardiomyopathy is typically preceded by a series of gradually progressive, asymptomatic changes in structure and function of the heart that can be ameliorated with treatment, prompting specialist organisations to endorse guidelines on cardiac surveillance in at-risk survivors of cancer. In 2015, the International Late Effects of Childhood Cancer Guideline Harmonization Group compiled these guidelines into a uniform set of recommendations applicable to a broad spectrum of clinical environments with varying resource availabilities. Since then, additional studies have provided insight into dose thresholds associated with a risk of asymptomatic and symptomatic cardiomyopathy, have characterised risk over time, and have established the cost-effectiveness of different surveillance strategies. This systematic Review and guideline provides updated recommendations based on the evidence published up to September, 2020.

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Declaration of interests AN reports research support from Amgen; a research contract with Bristol Myers Squibb; consulting fees from AstraZeneca, Boehringer Ingelheim, and Bantam Pharmaceuticals; and participation on a data safety monitoring board for Takeda Oncology. CP reports personal honoraria and expenses for presentation at education meetings from Amgen, Incyte, Ipsen, Novartis, and Servier. LSC reports grant funding from the University of Alabama for the Children's Oncology Group Guidelines, payment or honoraria for lectures or presentations from the American Society of Hematology and the University of Miami, and participation in the National Cancer Institute PDQ Pediatric Oncology Board. EJC is the Principal Investigator on a research grant to his institution from Abbott Laboratories. All other authors declare no competing interests.