Adverse effects of treatment in childhood acute lymphoblastic leukemia: general overview and implications for long-term cardiac health

Abstract

Survival of childhood acute lymphoblastic leukemia (ALL) is one of the greatest medical success stories of the last four decades. Unfortunately, childhood ALL survivors experience medical late effects that increase their risk of morbidity and premature death, often due to heart and vascular disease. Research has helped elucidate the mechanisms and trajectory of direct damage to the heart from treatment exposure, particularly to anthracyclines, and has also contributed knowledge on the influences of related chronic conditions, such as obesity and insulin resistance on heart health in these survivors. This article summarizes the key issues associated with early morbidity and mortality from cardiac-related disease in childhood ALL survivors and suggests directions for interventions to improve long-term outcomes.

Evaluation of Cardiotoxicity by Tissue Doppler Imaging in Childhood Leukemia Survivors Treated with Low-Dose Anthracycline

“…Despite the increase in the prevalence of childhood malignancies, the 5-year survival rate for ALL has approached 90 % as a result of advances in chemotherapy and supportive care [17,21]. This increase in survival has increased the importance of long-term treatment-related morbidity and mortality.…”

Selective inhibition of cell death in malignant vs normal B-cell precursors: implications for cAMP in development and treatment of BCP-ALL

“…This is partly aimed at increasing treatment efficiency in diagnostic subgroups with poor prognosis and partly aimed to reduce the incidence of late effects of intensive chemotherapy such as secondary neoplasms, endocrine dysfunction, cardiac-related disease, and cognitive and psychosocial problems. 4,5 Adult ALL patients generally have a poorer prognosis, with overall survival rates of 40% to 50%. 6 Principles of treatment are similar as for pediatric patients but with the addition of irradiation, which is still employed against central nervous system involvement and localized infiltrates.…”

Structural modifications in the sugar moiety as a key to improving the anticancer effectiveness of doxorubicin

“…Unfortunately, despite the clinical benefits of DOX, its use is often limited by serious adverse effects, such as severe cardiotoxicity and myelosuppression [5,9,10]. Severe dose-dependent cardiotoxicity occurs in~50% of patients treated with DOX.…”