Key result
Anthracycline exposure in pediatric cancer patients was associated with a 9.5% rate of abnormal LVEF (p=0.026), an effect mainly driven by high cumulative doses (>300 mg/m2).
Why the study?
Cardiotoxicity is the most important dose-limiting toxicity of anthracyclines, prompting investigation into the frequency of anthracycline-induced cardiomyopathy in pediatric malignancies in Khuzestan Province, Iran.
Does anthracycline treatment reduce LVEF in pediatric patients with malignancies?
Case-Control (n=112)
Does anthracycline treatment reduce LVEF in pediatric patients with malignancies?
p-value: p=0.026
High cumulative doses of anthracyclines (>300 mg/m2) are significantly associated with reduced LVEF and LVFS in pediatric cancer patients, highlighting the dose-dependent nature of cardiotoxicity.
Anthracycline cardiotoxicity warrants ongoing clinical vigilance; leaves open optimal surveillance and prevention strategies for prospective trials.
Background: Anthracyclines are widely used chemotherapeutic agents in several cancers. Since its use, survival improved significantly among cancer patients and has been reported to be up to 80%. However, anthracyclines possess several cardiac, renal and hematological toxicities which limit their use in practice. Cardiotoxicity is still the most important and dose-limiting side effect of anthracycline treatment. Here we aimed to investigate the frequency of anthracyclineinduced cardiomyopathy in pediatric malignancies in Khuzestan Province, Iran. Methods: A total of 112 patients were enrolled in the present study. Patients were allocated to the case or control group based on receiving anthracycline. Echocardiographic examinations were performed by a cardiologist. Electrocardiograms were also recorded. Results: We showed that cancer patients who underwent anthracycline treatment showed cardiomyopathy as defined by lower LVEF (Left Ventricular Ejection Fraction) among patients (p = 0.041). Abnormal LVEF was reported with a frequency of about 9.5% in patients (p = 0.026). However, LVFS (Left Ventricular Fraction Shortening), QRS voltage and QT interval did not differ significantly between treatment and control groups. Our data analysis revealed that this difference is mainly related to high cumulative dose since high cumulative dose of anthracycline (>300 mg/m2) leads to lower LVEF and LVFS and higher QRS voltage in comparison with lower cumulative dose (<300 mg/m2) and control group; but there was no significant difference between low dose and control group. Different age groups and type of malignancy including hematological and solid tumors did not show any significant differences for echocardiographic and electrocardiograms parameters. Conclusion: In our study, lower LVEF among patients who received anthracyclines were mainly related to a high cumulative dose of anthracyclines, which emphasizes the effect of cumulative dose for cardiotoxic effects. Larger studies are needed to investigate possible other risk factors for cardiotoxicity.
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Behrouzian et al. (2019) conducted a case-control in Pediatric malignancies (n=112). Anthracycline vs. Control group (no anthracycline) was evaluated on Abnormal LVEF (p=0.026). Anthracycline exposure in pediatric cancer patients was associated with a 9.5% rate of abnormal LVEF (p=0.026), an effect mainly driven by high cumulative doses (>300 mg/m2).
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