title: [High risk of cardiac dysfunction after treatment of secondary acute myeloid leukemia following chemotherapy and radiotherapy for breast cancer].
abstract: Secondary acute myeloid leukaemia (AML) occurring after breast cancer is a rare long-term complication of the chemo- and/or radiation therapy required to treat breast cancer. The usually recognized curative option of these secondary AML includes courses of anthracycline-based chemotherapy followed by haematopoietic stem cell transplantation (HSCT). Cardiac dysfunction during AML treatment of these patients previously treated with anthracyclines for breast cancer has not been reported to date. We evaluated the evolution of cardiac function in seven patients treated with anthracyclines and/or autologous or allogeneic bone marrow transplantation for secondary AML occurring after breast cancer. All of the patients who received a cumulative anthracycline dose above the cardiac toxicity threshold developed cardiac symptoms during AML chemotherapy courses. Moreover, four of the five transplanted patients developed severe heart failure among which two were fatal. Thus, the risk of severe cardiac dysfunction after treatment of secondary AML following breast cancer must be taken in account as part of the therapeutic strategy of those patients. As discussed here, an accurate evaluation of risk factors, the use of sensitive detection tests and of cardioprotective drugs as well as that of non-cardiotoxic chemotherapy might decrease the occurrence and severity of this life-threatening complication.
authors.affiliation: Service d'hématologie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France. lisewillems2@gmail.com
authors.forename: L
authors.initials: L
authors.lastname: Willems
authors.forename: F
authors.initials: F
authors.lastname: Suarez
authors.forename: E
authors.initials: E
authors.lastname: Messas
authors.forename: N
authors.initials: N
authors.lastname: Baubion
authors.forename: D
authors.initials: D
authors.lastname: Decaudin
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
authors.forename: D
authors.initials: D
authors.lastname: Ghez
authors.forename: R
authors.initials: R
authors.lastname: Delarue
authors.forename: O
authors.initials: O
authors.lastname: Hermine
authors.forename: A
authors.initials: A
authors.lastname: Buzyn
authors.forename: B
authors.initials: B
authors.lastname: Varet
authors.forename: M-T
authors.initials: MT
authors.lastname: Rubio
mesh_terms: D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006331:Heart Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000628:therapy*; D012074:Remission Induction; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology
chemical_list: D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D003630:Daunorubicin