Paediatrics and Child Health
Objectives: To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan.
Design: Prospective cohort study.
Setting: Aga Khan University, Karachi, Pakistan.
Participants: 110 children (aged 1 month–16 years).
Intervention: Anthracycline (doxorubicin and/or daunorubicin).
Outcome measurements: All children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 year was carried out by repeated measures analysis of variance.
Results: Mean age was 74±44 months and 75 (68.2%) were males. Acute lymphoblastic leukaemia was seen in 70 (64%) patients. Doxorubicin alone was used in 59 (54%) and combination therapy was used in 35 (32%). A cumulative dose of anthracycline /m2was used in 95 (86%). Fifteen (14%) children developed cardiac dysfunction within a month and 28 (25%) children within a year. Of these 10/15 (66.6%) and 12/28 (43%) had isolated diastolic dysfunction, respectively, while 5/15 (33.3%) and 16/28 (57%) had combined systolic and diastolic dysfunction. Seven (6.4%) patients expired due to severe cardiac dysfunction. Eight of 59 (13.5%) children showed dose-related cardiotoxicity (p=
Conclusions: Incidence of anthracycline-induced cardiotoxicity is high. Long-term follow-up is essential to diagnose its late manifestations.
Shaikh, A. S.,
Saleem, A. F.,
Mohsin, S. S.,
Alam, M. M.,
Ahmed, M. A.
(2013). Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan. BMJ Open, 3(11).
Available at: http://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/168