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Anthracycline-induced cardiotoxicity in patients with paediatric bone sarcoma and soft tissue sarcoma

Published online by Cambridge University Press:  07 August 2017

Ilaria Bini ,
Sebastian D. Asaftei ,
Chiara Riggi ,
Elisa Tirtei ,
Rosaria Manicone ,
Eleonora Biasin ,
Maria Eleonora Basso ,
Gabriella Agnoletti  and
Franca Fagioli
Ilaria Bini*
Affiliation:
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Sebastian D. Asaftei
Affiliation:
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Chiara Riggi
Affiliation:
Cardiology Department, Regina Margherita Children’s Hospital, Torino, Italy
Elisa Tirtei
Affiliation:
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Rosaria Manicone
Affiliation:
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Eleonora Biasin
Affiliation:
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Maria Eleonora Basso
Affiliation:
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Gabriella Agnoletti
Affiliation:
Cardiology Department, Regina Margherita Children’s Hospital, Torino, Italy
Franca Fagioli
Affiliation:
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
*
Correspondence to: I. Bini, MD, Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Torino, Italy. Tel: +39 011 313 5200; Fax: +39 011 313 5487; E-mail: ilariafrancesca.bini@gmail.com
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Abstract

Objectives

Anthracycline cardiotoxicity is an important side-effect in long-term childhood cancer survivors. We evaluated the incidence of and factors associated with anthracycline cardiotoxicity in a population of patients diagnosed with bone or soft tissue sarcoma.

Materials and methods

We retrospectively enrolled patients diagnosed with bone or soft tissue sarcoma, from 1995 to 2011, treated with anthracycline chemotherapy at our Centre and with a follow-up echocardiography carried out ⩾3 years from cardiotoxic therapy completion. Cardiac toxicity was graded using Common Terminology Criteria for Adverse Events version 4.0.

Results

A total of 82 patients were eligible. The median age at treatment was 11.9 years (1.44–18). We evaluated the median cumulative anthracycline dose, age at treatment, sex, thoracic radiotherapy, hematopoietic stem cell transplantation, and high-dose cyclophosphamide treatment as possible risk factors for cardiotoxicity. The median cumulative anthracycline dose was 390.75 mg/m2 (80–580). Of the 82 patients, 12 (14.6%) developed cardiotoxicity with grade ⩾2 ejection fraction decline: four patients were asymptomatic and did not receive any treatment; six patients were treated with pharmacological heart failure therapy; one patient with severe cardiomyopathy underwent heart transplantation and did not need any further treatment; and one patient died while waiting for heart transplantation. The median time at cardiac toxicity, from the end of anthracycline frontline chemotherapy, was 4.2 years (0.05–9.6). Cumulative anthracycline dose ⩾300 mg/m2 (p 0.04) was the only risk factor for cardiotoxicity on statistical analyses.

Conclusions

In our population, the cumulative incidence of cardiotoxicity is comparable to rates in the literature. This underlines the need for primary prevention and lifelong cardiac toxicity surveillance programmes in long-term childhood cancer survivors.

Keywords

Anthracyclinecardiotoxicitychildren cancer survivorsbone sarcomasoft tissue sarcoma
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1815 - 1822
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Copyright
© Cambridge University Press 2017 

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