title: Cardiotoxicity of mitoxantrone treatment in a german cohort of 639 multiple sclerosis patients.
abstract: OBJECTIVE
  The aim of this study was to elucidate the role of therapy-related cardiotoxicity in multiple sclerosis (MS) patients treated with mitoxantrone and to identify potential predictors for individual risk assessment.
  
  
  METHODS
  Within a multicenter retrospective cohort design, cardiac side effects attributed to mitoxantrone were analyzed in 639 MS patients at 2 MS centers in Germany. Demographic, disease, treatment, and follow-up data were collected from hospital records. Patients regularly received cardiac monitoring during the treatment phase.
  
  
  RESULTS
  None of the patients developed symptomatic congestive heart failure. However, the frequency of patients experiencing cardiac dysfunction of milder forms after mitoxantrone therapy was 4.1% (26 patients) among all patients. Analyses of the risk for cardiotoxicity revealed that cumulative dose exposure was the only statistically relevant risk factor associated with cardiac dysfunction.
  
  
  CONCLUSIONS
  The number of patients developing subclinical cardiac dysfunction below the maximum recommended cumulative dose is higher than was initially assumed. Interestingly, a subgroup of patients was identified who experienced cardiac dysfunction shortly after initiation of mitoxantrone and who received a low cumulative dose. Therefore, each administration of mitoxantrone should include monitoring of cardiac function to enhance the treatment safety for patients and to allow for early detection of any side effects, especially in potential high-risk subgroups (as determined genetically).
authors.affiliation: Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Fleischer
authors.affiliation: Department of Neurology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Salmen
authors.affiliation: Department of Neurology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kollar
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Weyer
authors.affiliation: Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Siffrin
authors.affiliation: Department of Neurology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chan
authors.affiliation: Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Zipp
authors.affiliation: Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Luessi
keywords: cardiotoxicity; dose dependency; mitoxantrone; multiple sclerosis