Low-dose anthracyclines in childhood Acute Lymphoblastic Leukemia (ALL): no cardiac deterioration more than 20 years post-treatment
Tóm tắt
In children with cancer a well-known risk factor for cardiotoxicity is a high cumulative dose of anthracyclines, but little is known about cardiac function in low-dose anthracycline-treated survivors. Also, it is unclear if a safe anthracycline-dose exists at all. Cardiac function was assessed in 23 long-term ALL-survivors with a median follow-up of 22 years (range 19.5–24.5) post-treatment. Age at diagnosis and current age were 5.0 (2.0–14.0) and 29.0 (24.0–39.0) years. All 23 survivors were treated according to DCLSG protocol ALL-5, including 18–25 Gy cranial irradiation. Thirteen of them received 4 × 25 mg/m2 daunorubicin by randomization. Cardiac evaluation included blood pressure measurement, echocardiography, and (24 h-) electrocardiogram. Results were compared with an earlier assessment at median 12 years post-treatment. None of the survivors had cardiac abnormalities. Cardiac status of daunorubicin-treated survivors showed no deterioration compared with the previous assessment in 1995. After prolonged follow-up (more than 20 years post-treatment), ALL-survivors treated with low dose daunorubicin had no clinical relevant deterioration of cardiac function.
Tài liệu tham khảo
van Dalen EC, van der Pal HJ, Kok WE, Caron HN, Kremer LC. Clinical heart failure in a cohort of children treated with anthracyclines: a long-term follow-up study. Eur J Cancer. 2006;42:3191–8.
Lipshultz SE, Lipsitz SR, Sallan SE, Dalton VM, Mone SM, Gelber RD, et al. Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. J Clin Oncol. 2005;23:2629–36.
Elbl L, Hrstkova H, Chaloupka V. The late consequences of anthracycline treatment on left ventricular function after treatment for childhood cancer. Eur J Pediatr. 2003;162:690–6.
Kremer LC, van der Pal HJ, Offringa M, van Dalen EC, Voute PA. Frequency and risk factors of subclinical cardiotoxicity after anthracycline therapy in children: a systematic review. Ann Oncol. 2002;13:819–29.
Sorensen K, Levitt GA, Bull C, Dorup I, Sullivan ID. Late anthracycline cardiotoxicity after childhood cancer: a prospective longitudinal study. Cancer. 2003;97:1991–8.
Rammeloo LA, Postma A, Sobotka-Plojhar MA, Bink-Boelkens MT, Berg A, Veerman AJ, et al. Low-dose daunorubicin in induction treatment of childhood acute lymphoblastic leukemia: no long-term cardiac damage in a randomized study of the Dutch Childhood Leukemia Study Group. Med Pediatr Oncol. 2000;35:13–9.
Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr. 2003;16:1091–110.
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358–67.
Lown B, Wolf M. Approaches to sudden death from coronary heart disease. Circulation. 1971;44:130–42.
Haaksma J, Brouwer J, Mulder LJM, et al. Heart rate dependent changes in spectral analysis. Computers in cardiology. Los Angeles, CA: Computer Society Press; 45–48, 1994.
Heart Rate Variability. Standards of measurement, physiological interpretation and clinical use. Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043–65.
Brouwer C, Gietema J, van den Berg M, Bink-Boelkens M, Elzenga N, Haaksma J, et al. Long-term cardiac follow-up in survivors of a malignant bone tumour. Ann Oncol. 2006;17:1586–91.
Nysom K, Holm K, Lipsitz SR, Mone SM, Colan SD, Orav EJ, et al. Relationship between cumulative anthracycline dose and late cardiotoxicity in childhood acute lymphoblastic leukemia. J Clin Oncol. 1998;16:545–50.
Spirito P, Maron BJ. Influence of aging on Doppler echocardiographic indices of left ventricular diastolic function. Br Heart J. 1988;59:672–9.
Tjeerdsma G, Meinardi MT, Der Graaf WT, van den Berg MP, Mulder NH, Crijns HJ, et al. Early detection of anthracycline induced cardiotoxicity in asymptomatic patients with normal left ventricular systolic function: autonomic versus echocardiographic variables. Heart. 1999;81:419–23.