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Related Experiment Videos

Cardiac changes with cyclophosphamide

L J Steinherz, P G Steinherz, D Mangiacasale

    Medical and Pediatric Oncology
    |January 1, 1981
    PubMed
    Summary

    High-dose cyclophosphamide (CPM) can cause cardiac issues in children, particularly with doses over 170 mg/kg or combined with anthracyclines. Echocardiograms revealed cardiac changes in at-risk pediatric patients undergoing cancer treatment.

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    Area of Science:

    • Pediatric Oncology
    • Cardiotoxicity
    • Pharmacology

    Background:

    • Cyclophosphamide (CPM) is a widely used chemotherapeutic agent in pediatric oncology.
    • High-dose chemotherapy regimens, including CPM, are employed for treating solid tumors and prior to bone marrow transplantation.
    • Potential cardiotoxicity associated with chemotherapy requires careful monitoring in pediatric patients.

    Purpose of the Study:

    • To evaluate the incidence and nature of cardiac changes following high-dose cyclophosphamide (CPM) treatment in pediatric patients.
    • To identify specific patient groups at higher risk for CPM-induced cardiotoxicity.
    • To assess the clinical presentation and management of observed cardiac effects.

    Main Methods:

    • Serial echocardiographic (ECHO) studies were performed on 40 pediatric patients receiving high-dose CPM (80-200 mg/kg) for solid tumors.

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  • Patients' treatment history, including prior anthracycline and radiation exposure, was recorded.
  • Echocardiographic parameters were analyzed to detect cardiac abnormalities.

    • Main Results:

    • Cardiac changes were observed in 10/13 patients receiving CPM ≥ 170 mg/kg and in 11/19 patients receiving 120-140 mg/kg CPM after prior anthracyclines (≥ 100 mg/m²).
    • No cardiac changes were noted in 8 patients receiving lower CPM doses (< 160 mg/kg) and less than 100 mg/m² anthracyclines.
    • Pericardial effusion was the most common finding (15 patients), with 2 deaths due to hemorrhagic pancarditis. Other changes included ventricular dilation and impaired contractility.

    Conclusions:

    • Cardiac effects of high-dose cyclophosphamide are a significant concern in pediatric patients.
    • Patients receiving CPM doses ≥ 170 mg/kg/week or 120 mg/kg/week following anthracycline therapy (≥ 100 mg/m²) are at particular risk.
    • Close cardiac monitoring is essential for pediatric patients undergoing high-dose CPM chemotherapy.