title: Cardiac function in survivors of childhood acute myeloid leukemia treated with chemotherapy only: a NOPHO-AML study.
abstract: OBJECTIVE
  We report cardiac function of patients treated for Childhood acute myeloid leukemia with chemotherapy only according to three consecutive Nordic protocols.
  
  
  METHODS
  Ninety-eight of 138 eligible patients accepted examination with standardized echocardiography. Results were compared with age- and sex-matched controls.
  
  
  RESULTS
  The median age was 3 yr at diagnosis (range 0-15), and the median time from diagnosis to study was 11 yr (4-25). All but one patient had received doxorubicin and 90% had received mitoxantrone. The median cumulative dose of daunorubicin equivalents was 300 mg/m(2) (210-525). Left ventricular fractional shortening (LVFS) and ejection fraction (LVEF) were lower in patients than in controls (32.6% (SD 4.0) vs. 35.2% (SD 3.4), P = 0.002 and 59.9% (SD 5.5) vs. 64.2% (SD 4.4), P = 0.001). The myocardial performance index (MPI) was higher in patients than in controls (0.32 (SD 0.081) vs. 0.26 (SD 0.074), P < 0.0001). Cumulative dose of doxorubicin but not mitoxantrone was related to lower LVFS (P = 0.037) and LVEF (P = 0.016). Longer follow-up was associated with lower LVFS (P = 0.034). Higher MPI was associated with young age at diagnosis (P = 0.04) and longer follow-up (P = 0.031).
  
  
  CONCLUSIONS
  In this study, most patients had cardiac function within normal limits and reported very few cardiac symptoms. However, compared with healthy controls, they had significantly reduced left ventricular function.
authors.affiliation: Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Marianne
authors.initials: M
authors.lastname: Jarfelt
authors.affiliation: Department of Internal Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Andersen
authors.affiliation: Department of Pediatrics, University Hospital Oslo, Rikshospitalet, Oslo, Norway.
authors.forename: Heidi
authors.initials: H
authors.lastname: Glosli
authors.affiliation: Children's Hospital, Helsinki University, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Jahnukainen
authors.affiliation: Department of Pediatrics, Landspitalinn University Hospital, Reykjavik, Iceland.
authors.forename: Guðmundur K
authors.initials: GK
authors.lastname: Jónmundsson
authors.affiliation: Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Malmros
authors.affiliation: Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Karsten
authors.initials: K
authors.lastname: Nysom
authors.affiliation: Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D057566:Self Report; D016277:Ventricular Function, Left
keywords: acute myeloid leukemia; cardiotoxicity; children; late effects of cancer treatment