Low anthracyclines doses-induced cardiotoxicity in acute lymphoblastic leukemia long-term female survivors.
BACKGROUND
High dosage anthracyclines in pediatric patients with acute lymphoblastic leukemia (ALL) is associated with cardiotoxicity. However, data on the cardiac effects of lower cumulative doses of these drugs are not conclusive. The aim of this study was to assess the cardiac effects of low cumulative anthracycline doses in long-term survivors of ALL.


METHODS
Echocardiograms were performed on 62 long-term ALL survivors, without any overt or sub-clinical signs or symptoms of heart failure. The interval after stopping therapy was 12.6 ± 4.3 years; the mean cumulative dose of anthracyclines was 228.2 ± 42.3 mg/m(2) . Left ventricular (LV) structure and function were studied by echocolor-Doppler. An age, gender and body surface area (BSA) matched group of healthy subjects was used as controls. Cardiac data were analyzed before and after BSA normalization.


RESULTS
Long term survivors of ALL, showed a lower LV mass index, interventricular septal and posterior wall thickness, which were independently related to gender and to age at which the ALL diagnosis was made. Data analyzed according to gender showed that abnormalities were confined to the female group. No alterations were observed in the ALL male group versus the corresponding control group. No relationship was observed between the echocardiografic abnormalities and the duration of follow-up or the anthracycline mean dose employed.


CONCLUSIONS
In the absence of any signs or symptoms of heart failure, female ALL survivors treated with low cumulative anthracycline doses, showed a reduced LV mass and wall thickness. This suggests that in female ALL survivors an echocardyographic follow-up should be recommended.
Amigoni
Maria
M
Clinica Medica, Milano-Bicocca University and S.Gerardo Hospital, Monza, Milan, Italy.
Giannattasio
Cristina
C
Fraschini
Donatella
D
Galbiati
Marianna
M
Capra
Anna Clara Maria
AC
Madotto
Fabiana
F
Cesana
Francesca
F
Jankovic
Momcilo
M
Masera
Giuseppe
G
Mancia
Giuseppe
G
D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage* / Q000009:adverse effects; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002648:Child; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012307:Risk Factors; D017741:Survivors; D055815:Young Adult
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic