Low-dose anthracyclines in childhood Acute Lymphoblastic Leukemia (ALL): no cardiac deterioration more than 20 years post-treatment.
BACKGROUND
In children with cancer a well-known risk factor for cardiotoxicity is a high cumulative dose of anthracyclines, but little is known about cardiac function in low-dose anthracycline-treated survivors. Also, it is unclear if a safe anthracycline-dose exists at all.


METHODS
Cardiac function was assessed in 23 long-term ALL-survivors with a median follow-up of 22 years (range 19.5-24.5) post-treatment. Age at diagnosis and current age were 5.0 (2.0-14.0) and 29.0 (24.0-39.0) years. All 23 survivors were treated according to DCLSG protocol ALL-5, including 18-25 Gy cranial irradiation. Thirteen of them received 4 x 25 mg/m(2) daunorubicin by randomization. Cardiac evaluation included blood pressure measurement, echocardiography, and (24 h-) electrocardiogram. Results were compared with an earlier assessment at median 12 years post-treatment.


RESULTS
None of the survivors had cardiac abnormalities. Cardiac status of daunorubicin-treated survivors showed no deterioration compared with the previous assessment in 1995. CONCLUSION AND IMPLICATION FOR CANCER SURVIVORS: After prolonged follow-up (more than 20 years post-treatment), ALL-survivors treated with low dose daunorubicin had no clinical relevant deterioration of cardiac function.
Brouwer
C A J
CA
Subdivision Paediatric Oncology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands. c.a.j.brouwer@bkk.umcg.nl
Gietema
J A
JA
van den Berg
M P
MP
Bink-Boelkens
M T E
MT
Elzenga
N J
NJ
Haaksma
J
J
Kamps
W A
WA
Vonk
J M
JM
Postma
A
A
D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003630:Daunorubicin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D017741:Survivors; D013997:Time Factors
D018943:Anthracyclines; D000970:Antineoplastic Agents; D003630:Daunorubicin