Clinical heart failure in a cohort of children treated with anthracyclines: a long-term follow-up study.
The cumulative incidence of anthracycline-induced clinical heart failure (A-CHF) in a large cohort of 830 children treated with a mean cumulative anthracycline dose of 288 mg/m2 (median 280 mg/m2; range 15-900 mg/m2) with a very long and complete follow-up after the start of anthracycline therapy (mean 8.5 years; median 7.1 years; range 0.01-28.4 years) was 2.5%. A cumulative anthracycline dose of 300 mg/m2 or more was the only independent risk factor (relative risk (RR)=8). The estimated risk of A-CHF increased with time to 5.5% at 20 years after the start of anthracycline therapy; 9.8% if treated with 300 mg/m2 or more. In conclusion, 1 in every 10 children treated with a cumulative anthracycline dose of 300 mg/m2 or more will eventually develop A-CHF. This is an extremely high risk and it reinforces the need of re-evaluating the cumulative anthracycline dose used in different treatment protocols and to define strategies to prevent A-CHF which could be implemented in treatment protocols.
van Dalen
Elvira C
EC
Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. e.c.vandalen@amc.uva.nl
van der Pal
Helena J H
HJ
Kok
Wouter E M
WE
Caron
Huib N
HN
Kremer
Leontien C M
LC
D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D012307:Risk Factors
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic