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.
BACKGROUND
To investigate late cardiotoxicity in childhood acute lymphoblastic leukemia (ALL) survivors after induction treatment with or without daunorubicin (DNR; 25 mg/m(2), i.v., weekly, x4, cumulative dose 100 mg/m(2)).


METHODS
Cardiac function was assessed in 90 event-free survivors of childhood ALL, 11.4-17.8 years (median 14.8 years) after treatment according to the DCLSG protocol ALL V. In this protocol patients were randomized to receive (group B) or not to receive (group A) DNR 25 mg/m(2)/week i.v. during the first 4 weeks of induction treatment. Age at diagnosis was 1.2-14.9 years (median 4.5 years). The cardiac evaluation consisted of a history, physical examination, electrocardiogram (ECG), 24 hr ambulatory ECG, and echocardiography.


RESULTS
Electrocardiographic data, arrhythmias, left ventricular dimensions, left ventricular contractility, wall stress, and diastolic function were within normal limits in both groups. No difference could be shown between data from group A (n = 40) and group B (n = 50).


CONCLUSIONS
No late cardiac damage was demonstrated in childhood ALL survivors after induction treatment including a cumulative dose of 100 mg/m(2) DNR, compared to survivors who received the same treatment but without DNR. DNR 100 mg/m(2) given in 4 doses of 25 mg/m(2)/week appears to be a safe dose in induction treatment of ALL.
Rammeloo
L A
LA
Children's Cancer Center, University Hospital, Groningen, The Netherlands.
Postma
A
A
Sobotka-Plojhar
M A
MA
Bink-Boelkens
M T
MT
Berg
A
A
Veerman
A J
AJ
Kamps
W A
WA
D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects*; D003630:Daunorubicin / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D010865:Pilot Projects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012074:Remission Induction; D017741:Survivors
D000903:Antibiotics, Antineoplastic; D003630:Daunorubicin