Use of multiple biomarkers for evaluation of anthracycline-induced cardiotoxicity in patients with acute myeloid leukemia.
OBJECTIVE
To assess cardiac toxicity of anthracycline treatment with six biomarkers of cardiac injury: myoglobin, creatine kinase MB (CK-MB mass), cardiac troponin T (cTnT), cardiac troponin I (cTnI), heart-type fatty acid binding protein (H-FABP), glycogen phosphorylase BB (GPBB).


METHODS
We evaluated anthracycline-induced cardiotoxicity in 12 acute myeloid leukemia patients (mean age 51.3-/+10.7 years, 7 females). All biomarkers were measured at the baseline, after first chemotherapy (CT) with anthracyclines, after last CT with anthracyclines (total cumulative dose 479.8-/+106.2 mg/m2) and 6 months thereafter. Values above the reference range were considered elevated.


RESULTS
GPBB increased above the cut-off (7.30 microg/L) in 2 (16.7%) patients after first CT, in 3 (25.0%) patients after last CT and remained elevated in 2 (16.7%) patients within 6 months after CT. CTnI became elevated (above 0.40 microg/L) in 1 (8.3%) patient after first and last CT and within 6 months after CT. CTnT remained negative (below 0.01 microg/L) during CT in all patients. Six months after CT, delayed cTnT positivity was found in 1 (8.3%) patient. All patients with cTnI or cTnT positivity had elevated GPBB. Other biomarkers (myoglobin, CK-MB mass, H-FABP) remained within the reference range in all patients.


CONCLUSIONS
Our preliminary results suggest that GPBB could be a new promising marker for detection of anthracycline-related cardiotoxicity and probably superior to cardiac troponins. The predictive value for development of cardiomyopathy in the future is not clear and will be evaluated during a prospective follow-up.
Horacek
J M
JM
2nd Department of Medicine-Clinical Hematology, University Hospital and Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic. jan.hor@post.cz
Tichy
M
M
Jebavy
L
L
Pudil
R
R
Ulrychova
M
M
Maly
J
J
D000368:Aged; D018943:Anthracyclines / Q000633:toxicity*; D015415:Biomarkers / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000096:biosynthesis*; D005260:Female; D024981:Glycogen Phosphorylase / Q000378:metabolism; D006321:Heart / Q000187:drug effects*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy*; D013997:Time Factors
D018943:Anthracyclines; D015415:Biomarkers; D014408:Biomarkers, Tumor; D024981:Glycogen Phosphorylase; C528446:glycogen phosphorylase BB, human