Late cardiotoxicity after low dose of anthracycline therapy for acute lymphoblastic leukemia in childhood

Vandecruys, Els; Mondelaers, Veerle; Wolf, Daniël De; Benoît, Yves; Suys, Bert

doi:10.1007/s11764-011-0186-6

Cited by 74 publications

(60 citation statements)

References 26 publications

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“…However, recent studies indicate that cardiac toxicity is common even in some patients given low cumulative doses [3,9,23,26,27]. In addition, most previous studies have evaluated only LV systolic functions in anthracycline-induced cardiotoxicity.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Improvement in long-term survival in patients with acute childhood leukemia has led to the need for monitorization of chemotherapy-related morbidity and mortality. This study included 60 patients with acute lymphoblastic leukemia that were in remission for at least 2 years and 30 healthy controls. Systolic and diastolic function of myocardium was evaluated using conventional echocardiography and tissue Doppler imaging of the left ventricle, interventricular septum and right ventricle. Median age of patients was 11.7 years (range 10-14.9 years), and the median duration of remission was 4 years (range 2.5-5 years). All patients were treated with a low cumulative dose of adriamycin (100 mg/m(2)) according to the St. Jude Total-XIIIA protocol. The ejection fraction (EF) and fractional shortening were normal in the patient and control groups, even though EF values were significantly lower in the patients (69.5 ± 2.3 vs. 72.7 ± 3 %, P < 0.01). Myocardial systole (S m), early diastole (E m) and late diastole (A m) velocities in all segments of the myocardium were significantly lower in the patient group (P < 0.01 for all segments). Cardiotoxicity was noted in all segments of the myocardium in the patient group, despite the fact that they were all treated with a low cumulative dose of adriamycin. Based on these findings, we think that there is no safe dose for anthracyclines and periodic echocardiographic evaluation of both the left and right ventricles must be performed in all patients treated with anthracyclines, even at low doses.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…In a study by Nysom et al [14], after a median of 8.1 years since the end of anthracycline therapy, patients who received cumulative doses between 244 and 550 mg/m 2 experienced late anthracycline-related cardiotoxicity, as evidenced by depressed LV fractional shortening and increased LV dimension, whereas these conditions did not occur in 3 other cohorts who received relatively lower doses (0-23, 45 and 73-301 mg/m 2 ). According to another recent study in adolescent patients, about 13 years after treatment, subclinical events occurred in about 30% of the patients, even at doses of 180-240 mg/m 2 [15]. These findings suggest that there is no safe dose of anthracyclines.…”

Section: Cardiotoxicity Risk Factorsmentioning

confidence: 99%

Cardiotoxicity and Cardioprotection in Childhood Cancer

Lipshultz¹,

Sambatakos

Maguire

et al. 2014

Acta Haematol

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Children diagnosed with cancer are now living longer as a result of advances in treatment. However, some commonly used anticancer drugs, although effective in curing cancer, can also cause adverse late effects. The cardiotoxic effects of anthracycline chemotherapy, such as doxorubicin, and radiation can cause persistent and progressive cardiovascular damage, emphasizing a need for effective prevention and treatment to reduce or avoid cardiotoxicity. Examples of risk factors for cardiotoxicity in children include higher anthracycline cumulative dose, higher dose of radiation, younger age at diagnosis, female sex, trisomy 21 and black race. However, not all who are exposed to toxic treatments experience cardiotoxicity, suggesting the possibility of a genetic predisposition. Cardioprotective strategies under investigation include the use of dexrazoxane, which provides short- and long-term cardioprotection in children treated with doxorubicin without interfering with oncological efficacy, the use of less toxic anthracycline derivatives and nutritional supplements. Evidence-based monitoring and screening are needed to identify early signs of cardiotoxicity that have been validated as surrogates of subsequent clinically significant cardiovascular disease before the occurrence of cardiac damage, in patients who may be at higher risk.

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“…Hingga saat ini, penggunaan antrasiklin masih terbatas karena kardiotoksisitas yang ditimbulkan. [8][9][10] Dosis kumulatif maksimum antrasiklin yang aman agar kardiotoksisitas tidak terjadi masih belum diketahui. Sorensen dkk 11 melaporkan penggunaan dosis kumulatif >250-300 mg/m 2 harus dihindarkan.…”

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Fungsi Sistolik dan Diastolik Jantung pada Pasien Anak dengan Osteosarkoma yang Mendapat Terapi Doksorubisin Di RS Cipto Mangunkusumo

Handojo

Sjakti

Yanuarso

et al. 2016

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Latar belakang. Doksorubisin merupakan obat golongan antrasiklin yang penting dan efektif pada pengobatan tumor padat pada anak. Doksorubisin mencegah sintesis RNA dan DNA melalui proses interkalasi. Kardiotoksisitas dilaporkan paling banyak karena penggunaan doksorubisin tersebut sehingga penggunaannya masih terbatas.Tujuan. Mengetahui fungsi jantung pada anak dengan osteosarkoma setelah mendapat terapi doksorubisin di RSCM.Metode. Studi deskriptif potong lintang dilakukan di RSCM, Divisi Hematologi-Onkologi IKA dan Sub Bagian Onkologi Orthopedik dan Traumatologi, dengan menelusuri catatan registrasi dan rekam medis pasien anak dengan osteosarkoma sejak 1 Januari 2005 sampai dengan 31 Desember 2012.Hasil. Terdapat 25 subjek penelitian, 21 di antaranya selesai menjalani kemoterapi dan mendapat total dosis kumulatif doksorubisin dengan rentang 300 mg/m2 sampai 675 mg/m2. Fungsi sistolik LV mengalami penurunan rerata fraksi ejeksi 3,3% dan pemendekan 2,5% setelah mendapat doksorubisin. Fungsi diastolik LV mengalami penurunan rerata rasio E/A 17,6%. Sembilan dari 18 pasien yang selesai menjalani kemoterapi dan mendapat total dosis kumulatif doksorubisin 375 mg/m2 mengalami gangguan fungsi diastolik tidak disertai gangguan fungsi sistolik. Kardiomiopati dilatasi ditemukan pada satu pasien setelah mendapat dosis kumulatif doksorubisin 300 mg/m2 dan satu pasien setelah mendapat dosis 675 mg/m2. Pasien berusia ≥10 tahun dan berjenis kelamin perempuan lebih banyak mengalami penurunan fungsi sistolik dan diastolik LV setelah mendapat doksorubisin.Kesimpulan. Fungsi sistolik dan diastolik LV menurun setelah pasien mendapat terapi doksorubisin dengan dosis kumulatif 300 mg/m2. Penurunan fungsi diastolik mendahului penurunan fungsi sistolik LV. Dosis, usia, dan jenis kelamin perempuan dapat menjadi faktor risiko penurunan fungsi jantung setelah pemberian doksorubisin.

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Late cardiotoxicity after low dose of anthracycline therapy for acute lymphoblastic leukemia in childhood

Cited by 74 publications

References 26 publications

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

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

Cardiotoxicity and Cardioprotection in Childhood Cancer

Fungsi Sistolik dan Diastolik Jantung pada Pasien Anak dengan Osteosarkoma yang Mendapat Terapi Doksorubisin Di RS Cipto Mangunkusumo

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