Anthracycline-Induced Clinical Heart Failure in a Cohort of 607 Children: Long-Term Follow-Up Study

Kremer, Leontien C. M.; Dalen, Elvira C. van; Offringa, Martin; Ottenkamp, Jaap; Voûte, P. A.

doi:10.1200/jco.2001.19.1.191

Cited by 362 publications

(245 citation statements)

References 21 publications

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“…Consistent with previous studies, cumulative anthracycline dose, radiation to a field that involved the heart, younger age at treatment and female gender were identified as risk factors for abnormal surveillance echocardiograms. Although there is compelling evidence that exposure to anthracycline chemotherapy can cause long-term myocardial dysfunction [10,28], there is no consensus on the indications for periodic cardiac surveillance or on the optimal frequency of this surveillance. Pharmacologic interventions, such as angiotensin converting enzyme (ACE) inhibitors, have been shown to slow the rate of cardiac deterioration in some patients with anthracycline-induced cardiomyopathy, but do not appear to prevent the eventual progression of the disease [29,30].…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic surveillance for asymptomatic late‐onset anthracycline cardiomyopathy in childhood cancer survivors

Abosoudah

Greenberg

Ness

et al. 2011

Pediatric Blood & Cancer

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BackgroundThe optimal frequency of echocardiographic surveillance in asymptomatic childhood cancer survivors exposed to anthracyclines has not been established. We evaluated the effectiveness of performing surveillance echocardiograms according to the Children's Oncology Group's (COG) Long‐Term Follow‐Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers in survivors ≥1 year from concluding therapy.MethodsWe reviewed all children treated at our institution with anthracycline chemotherapy from 1995 to 2003. We assessed the frequency of abnormal echocardiograms according to risk groups defined in the COG guidelines, and evaluated the risk factors for an abnormal echocardiogram using Cox proportional hazards modeling.ResultsAt least one echocardiogram was completed by 469/603 (77.8%) eligible survivors. Mean diagnosis age was 7.7 (SD = 4.6) years. Mean cumulative doxorubicin‐equivalent dose was 205 mg/m2 (SD = 115). Survivors completed 1,013 echocardiograms (median = 2, range = 1–10) beyond 1 year after concluding therapy. Seventy‐nine (16.8%) survivors had an abnormal echocardiogram at a median of 2.9 years (range 0.01–9.8) from 1 year after concluding therapy. Anthracycline dose >300 mg/m2 (hazard ratio [HR] 3.00; 95% CI 1.51–5.98), age 1–4 years at treatment (HR 1.89; 95% CI 1.08–3.31) and radiation to a field involving the heart (HR 1.73; 95% CI 1.08–2.76) predicted an increased risk of an abnormal echocardiogram; however, even survivors in the lower COG risk groups demonstrated abnormalities.ConclusionPeriodic echocardiographic surveillance in childhood cancer survivors can yield abnormalities that require further evaluation. Abnormalities may become evident as early as 1 year after the conclusion of therapy and can impact even those survivors considered to be at low risk. Pediatr Blood Cancer 2011; 57: 467–472. © 2011 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic surveillance for asymptomatic late‐onset anthracycline cardiomyopathy in childhood cancer survivors

Abosoudah

Greenberg

Ness

et al. 2011

Pediatric Blood & Cancer

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“…cTn's have recently been applied to the early detection of chemotherapy-induced cardiac toxicity, 117 where they have shown predictive value for long-term, cumulative cardiac damage by anthracycline. 118 In the HD chemotherapy setting, plasma cTnI levels were measured for up to 72 h after every HD chemotherapy cycle (often containing anthracyclines) with repeated 2D echo examination for up to 7 months after therapy in a large series of patients. Patients with cTnI levels o0.4 ng/ml had a small median drop in LVEF at 3 months follow-up examination, which subsequently normalized, whereas those with cTnI levels 40.4 ng/ml had a greater decrease in LVEF (16%), which was still evident at later follow-up.…”

Section: Circulating Markersmentioning

confidence: 99%

Cardiac toxicity of high-dose chemotherapy

Morandi

Ruffini

Benvenuto

et al. 2004

Bone Marrow Transplant

148

104

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Summary:Cardiac toxicity is an uncommon but potentially serious complication of high-dose (HD) chemotherapy and little is known about incidence, severity and underlying mechanisms. We have systematically reviewed the literature of the last 30 years to summarize and appraise the published evidence on cardiac toxicity associated with HD chemotherapy. HD cyclophosphamide-containing regimens have been most commonly associated with cardiac toxicity, with a progressively decreasing incidence over time. Dosage, application regimens and coadministration of other chemotherapeutic agents emerged as risk factors. While cardiac toxicity has been rarely associated with other cytotoxic drugs, an unexpected incidence of severe cardiotoxicity resulted from reduced-intensity conditioning regimens containing melphalan and fludarabine. Predictive value of cardiologic examination of patients is limited, and patients with a slight depression of cardiac performance could tolerate HD chemotherapy. Clinical examination, resting electrocardiography and dosage adjustment in overweight patients remain the mainstay of prevention, with bidimensional echocardiography (2D echo) for patients with a history of anthracycline exposure. Strategies to decrease the long-term negative impact of anthracycline administration on cardiac performance are being investigated. New 2D echo-based techniques and circulating markers of cardiac function hold promise for allowing identification of patients at high risk for and early diagnosis of cardiac toxicity.

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“…The whole blood was centrifuged and plasma immediately frozen and stored at À701C. Circulating NT-proBNP (antiserum to NT-proBNP [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] ) and NT-proANP (antiserum to NT-proANP 46-79 ) concentrations were determined by radioimmunoassays as previously described. Molecular heterogeneity has a major impact on the measurement of circulating N-terminal fragments of A-and B-type natriuretic peptides.…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

Very acute cardiac toxicity during BEAC chemotherapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation

Kuittinen

Husso-Saastamoinen

Sipola

et al. 2005

Bone Marrow Transplant

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Summary:Cardiotoxicity is potentially the most threatening nonhaematological side effect of high-dose CY. We prospectively evaluated the very acute cardiac effects of high-dose CY in 17 adult non-Hodgkin's lymphoma (NHL) patients receiving CY 1500 mg/m 2 /day as a part of BEAC high-dose therapy (HDT). Magnetic resonance imaging (MRI) and plasma natriuretic peptide (NT-proBNP, NT-proANP) measurements were performed prior to HDT (d-7) and just after completing HDT (d-2). After the high-dose CY left atrial end-systolic area increased from 15.271.2 to 18.571.4 cm 2 (P ¼ 0.001), left ventricular end-diastolic volume from 136.1712.3 to 156.6711.1 cm 3 (P ¼ 0.04) and left ventricular end-systolic volume from 67.477.8 to 75.377.1 cm 3 (P ¼ 0.018). However, no significant change in left ventricular ejection fraction (LVEF) was observed. At the same time, plasma levels of NT-proBNP increased from 134.9753.3 to 547.17168.4 pmol/l (P ¼ 0.003) and NT-proANP from 481.17105.5 to 1056.67193.1 pmol/l (P ¼ 0.001), respectively. To conclude, high-dose CY results in very acute cardiac toxicity characterised by enlargement of the heart chambers in NHL patients previously treated with anthracyclines. This toxicity can be detected with increased concentrations of circulating natriuretic peptides but not with LVEF measurement.

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Anthracycline-Induced Clinical Heart Failure in a Cohort of 607 Children: Long-Term Follow-Up Study

Cited by 362 publications

References 21 publications

Echocardiographic surveillance for asymptomatic late‐onset anthracycline cardiomyopathy in childhood cancer survivors

Echocardiographic surveillance for asymptomatic late‐onset anthracycline cardiomyopathy in childhood cancer survivors

Cardiac toxicity of high-dose chemotherapy

Very acute cardiac toxicity during BEAC chemotherapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation

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