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Published on: July 20, 2016
Cardiac function in survivors of acute lymphoblastic leukaemia and Hodgkin's lymphoma
Maryna Krawczuk-Rybak1, Lucja Dakowicz, Andrzej Hryniewicz
1Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Bialystok, Poland. rybak@umwb.edu.pl
Insights
Plasma N-terminal-pro-brain natriuretic peptide (BNP) levels were elevated in children treated for leukemia and lymphoma. Higher pro-BNP may signal early myocardial dysfunction post-cancer therapy, even without major echocardiographic changes.
Area of Science:
- Cardiology
- Pediatric Oncology
- Biochemistry
Background:
- Cardiotoxicity is a significant concern in pediatric cancer survivors treated with anthracyclines and mediastinal radiotherapy.
- Assessing subclinical myocardial dysfunction is crucial for long-term health outcomes in these patients.
Purpose of the Study:
- To evaluate plasma N-terminal-pro-brain natriuretic peptide (BNP) levels in children post-treatment for acute lymphoblastic leukemia and Hodgkin's lymphoma.
- To assess left ventricular mass, systolic, and diastolic functions in relation to treatment variables.
Main Methods:
- Plasma pro-BNP levels were measured in 44 children treated for leukemia or lymphoma.
- Echocardiography was performed to evaluate left ventricular parameters.
- Data were analyzed concerning gender, age at onset, time since therapy, anthracycline dose, and radiotherapy.
Main Results:
- Median pro-BNP levels were higher in the study group compared to controls (P=0.059).
- Elevated pro-BNP (>80.0 ng/mL) was observed in 11/44 patients.
- A negative correlation was found between pro-BNP and time since therapy completion (r=-0.378, P=0.009).
- Ejection fractions were normal, but indexed stroke volume was reduced in 16/44 patients.
Conclusions:
- Increased pro-BNP levels post-cardiotoxic cancer therapy may indicate early myocardial dysfunction.
- These findings suggest potential subclinical cardiac changes despite normal major echocardiographic parameters.
Aim:
The study objective was to assess plasma N-terminal-pro-brain natriuretic peptide (BNP) levels and to evaluate left ventricular mass as well as left ventricular systolic and diastolic functions in 44 children who had undergone treatment for acute lymphoblastic leukaemia and Hodgkin's lymphoma, with regard to gender, age at disease onset, time that had passed since therapy completion, cumulative dose of antracyclines and mediastinal radiotherapy applied.
Methods:
The median levels of pro-BNP were found to be higher in the whole study group as compared with the control (55.9 ± 53.1 ng/mL vs. 38.5 ± 47.7 ng/mL, P= 0.059). The pro-BNP values >80.0 ng/mL (standard deviation score (SDS)) were noted in 11/44 patients, including those exceeding 115.0 ng/mL (2 SDS) - in 6/44 patients.
Results:
No correlation was observed of pro-BNP levels with the accumulated dose of antracyclines (r=-0.42, P= 0.79) or mediastinal radiotherapy (r= 0.197, P= 0.2). However, negative correlation was found between pro-BNP and the time that had passed since therapy completion (r=-0.378, P= 0.009). In echocardiography, shortening and ejection fractions remained normal, whereas the indexed stroke volume was below 40 mL/m(2) in 16/44 patients. The E/A index below 1.5 was found in 6/44 cases. The left ventricular systolic mass remained within the normal range. Negative correlation was noted between isovolumetric diastolic time and pro-BNP level.
Conclusions:
Increased levels of pro-BNP after anti-cancer treatment with the involvement of cardiotoxic substances may indicate the first symptoms of myocardial dysfunction, despite the lack of major echocardiographic disorders.
