title: Evaluation of cardiotoxicity by tissue Doppler imaging in childhood leukemia survivors treated with low-dose anthracycline.
abstract: Improvement in long-term survival in patients with acute childhood leukemia has led to the need for monitorization of chemotherapy-related morbidity and mortality. This study included 60 patients with acute lymphoblastic leukemia that were in remission for at least 2 years and 30 healthy controls. Systolic and diastolic function of myocardium was evaluated using conventional echocardiography and tissue Doppler imaging of the left ventricle, interventricular septum and right ventricle. Median age of patients was 11.7 years (range 10-14.9 years), and the median duration of remission was 4 years (range 2.5-5 years). All patients were treated with a low cumulative dose of adriamycin (100 mg/m(2)) according to the St. Jude Total-XIIIA protocol. The ejection fraction (EF) and fractional shortening were normal in the patient and control groups, even though EF values were significantly lower in the patients (69.5 ± 2.3 vs. 72.7 ± 3 %, P < 0.01). Myocardial systole (S m), early diastole (E m) and late diastole (A m) velocities in all segments of the myocardium were significantly lower in the patient group (P < 0.01 for all segments). Cardiotoxicity was noted in all segments of the myocardium in the patient group, despite the fact that they were all treated with a low cumulative dose of adriamycin. Based on these findings, we think that there is no safe dose for anthracyclines and periodic echocardiographic evaluation of both the left and right ventricles must be performed in all patients treated with anthracyclines, even at low doses.
authors.affiliation: Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey, cengizbayram2013@gmail.com.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Bayram
authors.forename: İlker
authors.initials: İ
authors.lastname: Çetin
authors.forename: Betul
authors.initials: B
authors.lastname: Tavil
authors.forename: Nese
authors.initials: N
authors.lastname: Yarali
authors.forename: Filiz
authors.initials: F
authors.lastname: Ekici
authors.forename: Pamir
authors.initials: P
authors.lastname: Isık
authors.forename: Bahattin
authors.initials: B
authors.lastname: Tunc
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D066126:Cardiotoxicity / Q000000981:diagnostic imaging* / Q000209:etiology*; D002648:Child; D003952:Diagnostic Imaging; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy; D008297:Male; D017741:Survivors / Q000706:statistics & numerical data*
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic