Key result
Aggressive therapy including cardiac transplantation successfully rescues severe low-dose doxorubicin cardiomyopathy.
Why the study?
Symptomatic cardiac failure can occur at cumulative doxorubicin doses below the generally considered safe threshold of 500-550 mg/m2 when objective cardiac function measures are used.
Case Report (n=2)
Severe doxorubicin-induced cardiomyopathy can occur at cumulative doses below 500 mg/m2 and may require aggressive interventions such as cardiac transplantation for survival.
Answers are grounded in this paper and cite their sources.
May prompt cardiomyopathy vigilance at low doxorubicin doses; case reports leave open optimal management including transplantation.
There is a dose-effect relationship between doxorubicin and the incidence of symptomatic cardiac failure. It is generally thought that doses below 500-550 mg/m2 are safe but, when objective measures of cardiac function are used, it becomes apparent that degrees of cardiac failure occur at doses below this. We present here the case histories of two patients who developed very severe cardiac failure at cumulative doses well below 500 mg/m2 but who survived their initial cardiac illness due to aggressive intervention. In one case, the patient was successfully treated by orthotopic cardiac transplantation.
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Sriskandan et al. (1994) conducted a case report in Doxorubicin-induced cardiomyopathy (n=2). Aggressive intervention (including orthotopic cardiac transplantation) was evaluated on Survival of initial cardiac illness. Aggressive intervention, including orthotopic cardiac transplantation, successfully treated two patients who developed severe doxorubicin-induced cardiomyopathy at cumulative doses well below 500 mg/m2.
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