Lipshultz SE, Alvarez JA, Scully RE. Anthracycline associated cardiotoxicity in survivors of childhood cancer

Department of Pediatrics, Leonard M Miller School of Medicine, University of Miami, Holtz Children's Hospital of the University of Miami/Jackson Memorial Medical Center, Miami, FL 33101, USA.
Heart (British Cardiac Society) (Impact Factor: 5.6). 05/2008; 94(4):525-33. DOI: 10.1136/hrt.2007.136093
Source: PubMed
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    • "The anthracycline and related compounds (doxorubicin, daunorubicin) are the backbone of current childhood chemotherapy (solid and hematological malignancies) [1]. Despite the fact that they are very potent and highly effective chemotherapeutic agents, their cardiotoxicity remains a serious concern during management [1] [2], with the incidence of cardiotoxicity ranges between 0 -57 percent [3]. Their main adverse effects include systolic and diastolic dysfunction, cardiomyopathy, arrhythmias and pericardial effusion [1] [2] [4]. "
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    ABSTRACT: Abstract 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/m2 (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/m2, 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.
    World Journal of Cardiovascular Diseases 06/2014; 4(07):377-83. DOI:10.4236/wjcd.2014.47047. · 0.22 Impact Factor
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    • "Despite consistent clinical benefit observed with anthracycline-based regimens in breast cancer, significant toxicities that include acute and/or chronic cardiac dysfunction have limited more expansive therapeutic use, specifically with HER2-suppressing agents. Doxorubicin-induced cardiac damage is irreversible, resulting in acute injury and also damage that can manifest itself years after treatment (Lipshultz et al., 2008). Exposure to cumulative concentrations of doxorubicin above 550 mg/m 2 increases the potential for cardiomyopathy and heart failure (Lefrak et al., 1973; Von Hoff et al., 1979). "

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    • "Long-term effects of radiation on the cardiovascular system can include premature coronary artery disease, constrictive pericarditis, and pericardial effusions (27). Further, the chemotherapeutic classes of Anthracyclines are agents generally associated with cardiac sequelae such as acute-arrhythmias, hypotension, and a decrease in cardiac function, which can lead to congestive heart failure (28). "
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    ABSTRACT: Reproductive health among cancer survivors is an important quality of life issue. Certain cancer therapies have known fertility risks. There is an existing cohort of adolescents and young adults (AYA) cancer survivors that, seen less frequently in clinical care settings than active patients, are likely not having discussions of fertility and other reproductive health issues. A survivor or healthcare provider can easily assume that the window of opportunity for fertility preservation has passed, however emerging research has shown this may not be the case. Recent data demonstrates a close relationship between fertility and other late effects to conclude that ongoing assessment during survivorship is warranted. Some fertility preservation procedures have also been shown to mitigate common late effects. This review explores the link between late effects from treatment and common comorbidities from infertility, which may exacerbate these late effects. This review also highlights the relevance of fertility discussions in the AYA survivorship population.
    Frontiers in Oncology 10/2013; 3:248. DOI:10.3389/fonc.2013.00248
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