title: Severe and fatal anthracycline cardiotoxicity at cumulative doses below 400 mg/m2: evidence for enhanced toxicity with multiagent chemotherapy.
abstract: Three cases of severe, progressive, and in two cases, fetal cardiomyopathy secondary to anthracycline chemotherapy are reported. All of the patients were receiving multiagent chemotherapy for extremity sarcomas consisting of doxorubicin, high-dose methotrexate, bleomycin, cyclophosphamide, dactinomycin, and cisplatinum at the onset of their congestive heart failure. Cardiomyopathy developed in each patient at cumulative anthracycline doses less than 400 mg/m2. These cases suggest that enhanced cardiotoxicity may occur when anthracyclines are used in combination with other agents such as cyclophosphamide, bleomycin, cisplatinum, and methotrexate and that cumulative anthracycline doses considered to be "safe" may need to be lowered in these circumstances.
authors.affiliation: Division of Pediatric Hematology-Oncology, University of Albama, Birmingham 35233.
authors.forename: R G
authors.initials: RG
authors.lastname: Watts
mesh_terms: D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use / Q000633:toxicity*; D001761:Bleomycin / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000139:chemically induced / Q000401:mortality; D002648:Child; D002945:Cisplatin / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D012509:Sarcoma / Q000188:drug therapy
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin; D003609:Dactinomycin; D003520:Cyclophosphamide; D002945:Cisplatin; D008727:Methotrexate