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Late cardiotoxicity of anthracyclines in children with acute leukemia
B Zalewska-Szewczyk1, J Lipiec, J Bodalski
1II Clinic of Children's Diseases, Institute of Pediatrics, Medical University of Lódz.
Insights
Anthracycline chemotherapy for acute leukemia in children can lead to late-onset congestive heart failure. Many patients show subclinical heart muscle impairment, even with lower cumulative anthracycline doses.
Area of Science:
- Cardiology
- Pediatric Oncology
- Pharmacology
Background:
- Congestive heart failure is a severe late complication of anthracycline cancer therapy.
- Children treated for acute leukemia are at risk for cardiac dysfunction.
Purpose of the Study:
- To evaluate heart muscle function in children treated for acute leukemia.
- To assess the relationship between anthracycline dose and cardiac impairment.
Main Methods:
- Evaluated 50 children (5.5 to 20.7 years) with a history of acute leukemia.
- Assessed cardiac function using history, physical exam, ECG, exercise tests, and echocardiography.
- Analyzed cumulative anthracycline doses (120-550 mg/m2).
Main Results:
- Impaired heart muscle contractility observed in 32% of cases.
- Cardiac dysfunction correlated with total anthracycline dose and time since therapy.
- Heart muscle disorders detected even below 400 mg/m2 cumulative dose.
- Most heart damage was subclinical.
Conclusions:
- Anthracyclines pose a significant risk for late cardiac complications in pediatric leukemia survivors.
- Subclinical cardiac dysfunction is common and dose-dependent.
- Long-term cardiac monitoring is crucial for these patients.
Abstract:
Congestive heart failure is one the most severe late complications of cancer therapy with anthracyclines. The function of the heart muscle was evaluated in 50 children (30 boys and 20 girls), aged from 5 years 6 months to 20 years 7 months, treated in the past for lymphoblastic or nonlymphoblastic acute leukemia. The total dose of the administrated anthracyclines was 120-550 mg/m2. The circulatory system was evaluated on the basis of history, physical examination, ECG, exercise test and echocardiography. Impaired contractility of the heart muscle was found in 32% of cases. The degree of impairment was related to the total dose of anthracyclines and to the period from discontinuation of therapy. Heart muscle function disorders were present also in children, in whom the cumulative dose of anthracycline antibiotics did not exceed 400 mg/m2. In the majority of patients the evidence of heart damage was subclinical.