Cardiac damage after treatment of childhood cancer: A long-term follow-up

Velensek, Veronika; Mazić, Uroš; Kržišnik, Ciril; Demšar, Damjan; Jazbec, Janez; Jereb, Berta

doi:10.1186/1471-2407-8-141

Cited by 20 publications

(17 citation statements)

References 31 publications

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“…The Tei index and DT also showed significant changes (p=<0.001). These findings were consistent with the medical literature 28 29. Diastolic dysfunction has been reported to predict future systolic dysfunction,30 and the same was observed in our study as well.…”

Section: Discussionsupporting

confidence: 94%

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan

et al. 2013

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ObjectivesTo identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan.DesignProspective cohort study.SettingAga Khan University, Karachi, Pakistan.Participants110 children (aged 1 month–16 years).InterventionAnthracycline (doxorubicin and/or daunorubicin).Outcome measurementsAll children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 year was carried out by repeated measures analysis of variance.ResultsMean age was 74±44 months and 75 (68.2%) were males. Acute lymphoblastic leukaemia was seen in 70 (64%) patients. Doxorubicin alone was used in 59 (54%) and combination therapy was used in 35 (32%). A cumulative dose of anthracycline <300 mg/m2 was used in 95 (86%). Fifteen (14%) children developed cardiac dysfunction within a month and 28 (25%) children within a year. Of these 10/15 (66.6%) and 12/28 (43%) had isolated diastolic dysfunction, respectively, while 5/15 (33.3%) and 16/28 (57%) had combined systolic and diastolic dysfunction. Seven (6.4%) patients expired due to severe cardiac dysfunction. Eight of 59 (13.5%) children showed dose-related cardiotoxicity (p=<0.001). Cardiotoxicity was also high when the combination of doxorubicin and daunorubicin was used (p=0.004).ConclusionsIncidence of anthracycline-induced cardiotoxicity is high. Long-term follow-up is essential to diagnose its late manifestations.

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Section: Discussionsupporting

confidence: 94%

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan

et al. 2013

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“…Meanwhile, radiological, endocrinological, psychological or any additional evaluations needed in follow-up care, as well as screening for late eff ects of ALL treatment, are performed at our hospital. Screening, recognition and proper treatment of late eff ects are essential in providing the maximal quality of life [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

History of treatment and long-term outcome of childhood acute lymphoblastic leukemia in Slovenia

Avčin

Prelog

Kavčič

et al. 2011

memo

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Treatment and long-term outcome in Slovenian children and adolescents, treated for acute lymphoblastic leukaemia (ALL) were evaluated, mainly considering diff erences between treatment regimens being evolved during time. From year 1967From year through 2004 were treated and six therapeutic schemes had been used. Retrospectively 5-year overall survival ± standard error (5yOS), relapse rate (RR) and second neoplasm (SN) were estimated according to treatment regimen, age, and where recorded, also according to BFM risk group, white blood cell count and disease subtype. For treatment regimens used after year 1992, 5-year eventfree survival ± standard error (5yEFS) was added to our observations. Among 75 pts enrolled in pre-POG treatment regimen, the probability of 5yOS was 25.3 ± 5.0%, while no data for RR and SN analysis were available. For 91 pts treated according to POG derived treatment, the probability of 5yOS was 61.6 ± 5.1%, with 64% RR and 5.5% occurrence of SN. Probability of 5yOS of 74.3 ± 7.4%, RR of 37% and 8.5% occurrence of SN were reached for 35 pts enrolled in ALL-BFM 83 protocol. ALL-BFM 86 protocol included 62 pts with 69.4 ± 5.9% probability of 5yOS, 33% RR and 3.2% occurrence of SN. For ALL-BFM 90 protocol the 5yEFS and 5yOS for 71 pts was 77.3 ± 5.2% and 81.8 ± 4.8%, respectively, with 17% RR and 1.5% occurrence of SN. Fifty-six patients enrolled in ALL-BFM 95 protocol reached 83.0 ± 5.2% 5yEFS and 92.6 ± 3.6% 5yOS, with 16% RR and 1.7% occurrence of SN. Stepwise rise of OS, decline in RR, reducing occurrence of SN and, for ALL-BFM 90 and ALL-BFM 95 protocol, improvements in EFS, were observed through time according to diff erent treatment regimens. General improvement regarding OS, RR and occurrence of SN was most obvious after the application of BFM regimen with evident continuous rise in OS and decline in RR and occurrence of SN thereafter.

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“…Several studies have reported up to 56% subclinical echocardiographic cardiac dysfunction and incidence of clinical cardiotoxicity (CHF) ranged from 0 -16% [7]. Study conducted by Velensek et al [18] showed isolated diastolic dysfunction in 28.6% of patients.…”

Section: Demographic Profile (N) No Dysfunction (N = 82) Dysfunction mentioning

confidence: 99%

Risk Factors Associated with Anthracycline Induced Cardiac Dysfunction in Pediatric Patients

Shaikh¹,

Alam²,

Mohsin³

et al. 2014

WJCD

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Anthracyclines (i.e., doxorubicin, daunorubicin) have significant impact on outcome in many pediatric chemotherapy protocols and therefore remain the mainstay of treatment. The objective of this study was to identify the risk factors for anthracycline induced cardiac dysfunction in pediatric patients. Multiple logistic regression model was applied to assess the risk factors for development of cardiac dysfunction. 110 pediatric oncology patients were available for final analysis. 75 (66%) children were males and mean age was 74 ± 44 months. ALL (n = 70, 64%) was the most common primary diagnosis followed by lymphoma (n = 19; 17%) and AML (n = 12, 11%). Daunorubicin alone or in combination with doxorubicin was used in (n = 94, 85%) patients and cumulative dose < 300 mg was used in (n = 95; 86%) children. 24 (22%) children received radiation therapy as per protocol and sepsis were observed in 47 (43%) cases. Post anthracycline, 15 (14%) children had cardiac dysfunction within a month; out of them 10/15 (67%) had isolated diastolic dysfunction, while 28 (25%) developed dysfunction within a year. 19 (17%) had pericardial effusion. 11 expired and out of them, 7 had significant cardiac dysfunction. Cumulative dose > 300 mg/m 2 (p < 0.001; AOR 2.3), radiation therapy (p = 0.009; AOR 3.5) and sepsis (p = 0.002; AOR 2.6) were found to be independent risk factors associated anthracycline induced cardiac dysfunction. At univariant level use of daunorubicin alone or in combination therapy (p < 0.001, OR 7) and mode of delivery (p 0.048, OR 9.7) were also found statistically significant. In conclusion anthracycline induced cardiac dysfunction is mostly related to cumulative dose > 300 mg/m 2 , use of Daunorubicin alone or in combination with doxorubicin, mode of delivery, radiation therapy and sepsis. Regular long term follow-up with cardiologist is the key point for early diagnosis and therapy for a long term survival.

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Cardiac damage after treatment of childhood cancer: A long-term follow-up

Abstract: Background: With improved childhood cancer cure rate, long term sequelae are becoming an important factor of quality of life. Signs of cardiovascular disease are frequently found in long term survivors of cancer. Cardiac damage may be related to irradiation and chemotherapy.

Cited by 20 publications

References 31 publications

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan

History of treatment and long-term outcome of childhood acute lymphoblastic leukemia in Slovenia

Risk Factors Associated with Anthracycline Induced Cardiac Dysfunction in Pediatric Patients

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