Subclinical anthracycline cardiotoxicity in patients with acute promyelocytic leukemia in long-term remission after the AIDA protocol.
Anthracycline chemotherapy remains a critical component of cancer treatment despite its established risk of cardiotoxicity. To investigate whether the AIDA protocol, which combines idarubicin, mitoxantrone, and all-trans retinoic acid (ATRA) for treatment of acute promyelocytic leukemia (APL) results in late cardiotoxicity, 34 APL patients in long-term remission were evaluated. The cumulative dose of idarubicin and mitoxantrone were 80 mg/m(2) and 50 mg/m(2), respectively. Median follow-up was 7 years. Segmental wall motion abnormalities (SWMAs) were detected in 11 AIDA patients who still presented with an ejection fraction (EF) within normal limits (EF 56% in the AIDA group vs 59% in the control group, P=.01). However, parameters of diastolic dysfunction were significantly impaired in the AIDA group (E/A ratio: 1.04 in the AIDA group vs 1.28 in the control group, P=.001; E/E' lateral ratio: 10.04 in the AIDA group vs 5.79 in the control group, P≤.001) as well as left atrial volume (52 mL in the AIDA group vs 35 mL in the control group, P<.001). Cardiac toxicity due to anthracycline therapy is often frequent. Changes in diastolic function are helpful in the detection of subclinical anthracycline cardiotoxicity in long-term cardiac follow-up despite a preserved systolic ventricular function.
Department of Heart and Great Vessels, University of Rome La Sapienza, Rome, Italy. p.pel@libero.it
Pierpaolo
P
Pellicori
Angela
A
Calicchia
Francesco
F
Lococo
Giuseppe
G
Cimino
Concetta
C
Torromeo
D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D054715:Cardiotoxins / Q000009:adverse effects; D003971:Diastole; D005260:Female; D006801:Humans; D015255:Idarubicin / Q000009:adverse effects*; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D014212:Tretinoin / Q000009:adverse effects*; D055815:Young Adult
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D054715:Cardiotoxins; D014212:Tretinoin; D008942:Mitoxantrone; D015255:Idarubicin