Cumulative incidence and risk factors of mitoxantrone-induced cardiotoxicity in children: a systematic review.
Mitoxantrone is believed to maintain anthracycline antitumour activity but be associated with a reduced cardiotoxicity. The aim of this study was to evaluate the evidence for the cumulative incidence of and risk factors for mitoxantrone-induced cardiotoxicity (M-CT) in children treated for childhood cancers. After an extensive literature search, 17 studies were included. The cumulative incidence varied between 0 and 6.7% in the 16 studies evaluating symptomatic M-CT and between 0 and 80% in the 11 studies evaluating asymptomatic M-CT. Risk factors for developing M-CT remain unclear. All studies had serious methodological limitations. In conclusion, children treated with mitoxantrone are at risk of developing M-CT, but due to the low quality of the current evidence, the exact cumulative incidence and risk factors for M-CT remain unclear. It is too early to conclude that in children mitoxantrone is less cardiotoxic than anthracyclines. More well-designed studies are needed to reliably evaluate the incidence of M-CT and its associated risk factors.
van Dalen
E C
EC
Department of Paediatric Oncology, Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. e.c.vandalen@amc.uva.nl
van der Pal
H J H
HJ
Bakker
P J M
PJ
Caron
H N
HN
Kremer
L C M
LC
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D006331:Heart Diseases / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008942:Mitoxantrone / Q000009:adverse effects*; D012307:Risk Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D008942:Mitoxantrone