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Comparación aleatorizada de la cardiotoxicidad con 60 frente a 90 mg de daunorrubicina en la terapia de inducción de
Stefan Markus Dendorfer1,2, Katharina Schmidt-Brücken1, Michael Kramer1
1Department of Internal Medicine I, University Hospital TU Dresden, Dresden, Germany.
American journal of hematology
|January 6, 2026
Resumen
Las dosis más altas de daunorrubicina en la terapia de inducción de leucemia mieloide aguda (LMA) aumentan la cardiotoxicidad, como lo demuestran los niveles elevados de troponina. La monitorización cardíaca temprana es crucial para los pacientes que reciben tratamiento para la LMA.
Área de la Ciencia:
- Cardiología
- Hematología
- Oncología
Sus antecedentes:
- Las antraciclinas son vitales para la terapia de inducción de la leucemia mieloide aguda (LMA).
- La dosificación óptima de antraciclinas y los riesgos de cardiotoxicidad son objeto de debate.
- La daunorrubicina es una antraciclina clave utilizada en el tratamiento de la LMA.
Objetivo del estudio:
- Comparar los efectos cardiotóxicos de dos dosis de daunorrubicina (60 vs. 90 mg/m²) en la terapia de inducción de LMA.
- Evaluar la función cardíaca utilizando la fracción de eyección del ventrículo izquierdo (FEVI) y biomarcadores.
- Investigar la cardiotoxicidad de la daunorrubicina dependiente de la dosis.
Principales métodos:
- El ensayo DaunoDouble aleatorizó a 317 pacientes con LMA recién diagnosticada (18-65 años) a daunorrubicina 60 o 90 mg/m² con citarabina.
- La función cardíaca se evaluó mediante FEVI y biomarcadores cardíacos (hsTnT, NT-proBNP) antes del tratamiento y el día 15.
- Los análisis estadísticos compararon los cambios en la FEVI y los biomarcadores entre los brazos de tratamiento y a lo largo del tiempo.
Principales resultados:
- La FEVI disminuyó significativamente en todos los pacientes, sin diferencias significativas entre los grupos de dosis de daunorrubicina.
- Los niveles de troponina T de alta sensibilidad (hsTnT) aumentaron significativamente, observándose niveles más altos en el grupo de 90 mg/m² en comparación con el grupo de 60 mg/m².
- También se observaron niveles elevados de hsTnT post-inducción en pacientes con obesidad e hipertensión arterial.
Conclusiones:
- La daunorrubicina demuestra un efecto cardiotóxico dependiente de la dosis, incluso a dosis de inducción estándar.
- El aumento de los niveles de hsTnT sugiere una lesión miocárdica asociada con dosis más altas de daunorrubicina.
- La monitorización cardíaca temprana es esencial durante la terapia de inducción de LMA para detectar una posible cardiotoxicidad.
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