EVALUATION OF DOXORUBICIN INDUCED CARDIOTOXICITY IN CHILDREN WITH ACUTE LEUKEMIA.

Abstract

Background: Acute leukemia represents the most common malignant conditions of childhood,
accounting for one third of childhood cancer. Anthracyclines as Doxorubicin are highly effective
chemotherapeutic agents used in acute leukemia treatment but has cardiotoxicity as major side-effect
that may compromise their clinical effectiveness. Objectives: To identify the incidence of chronic
early and late onset subclinical anthracyclines-induced cardiotoxicity in children with acute leukemia.
Patients and methods: This prospective non-interventional study was carried out at Oncology Unit in
Pediatrics Department in Zagazig University Hospitals during the period from January 2008 to
December 2010. The study included 100 pediatric patients who were treated for acute leukemia and
received anthracyclines in their treatment protocols, they divided into two groups (I) and (II) each
contain 50 patients. We evaluated these patients using conventional echocardiography and Tissue
Doppler Imaging (TDI) together with blood sampling to determine serum level of NT-PBNP and
cardiac Troponin T (cTnT). Results: Aberration in diastolic stage of myocardial cycle in TDI study
may be an early sign of cardiotoxicity as in group (I).The follow up dependent aggravations of
subclinical cardiomyopathy is obvious in our study as detected in group (II). Regarding
echocardiography FS and EF were frequently abnormal in group (I) but in group (II) dilated LVEDD,
thinner IVS, decreased EF, FS and increased LVPW thickness were observed in patients with
subclinical cardiotoxicity.Plasma NT-pBNP was significantly elevated in 18% asymptomatic patients
in group (II) and in 10% of patients in group (I).Cumulative anthracyclines dosage > 300 mg/m2 is an
important risk factor to develop subclinical cardiotoxicity. Serum level of cTnT was not significantly
elevated in both groups after treatment by anthracyclines. Conclusion: Patients who received
anthracyclines should have lifelong follow-up using new highly sensitive non-invasive methods for
early detection of subclinical cardio toxicity.
Keywords: acute leukemia, cardiotoxicity, anthracyclines.