Cardiac toxicity 4 to 20 years after completing anthracycline therapy

Article Abstract:

Among the most useful drugs for treating cancer are the anthracyclines; unfortunately, their use is limited because of their ability to cause irreversible damage to the heart muscle, leading to heart failure. Heart damage most often occurs one to three months after anthracycline therapy is stopped, but can occur up to two years after the cessation of treatment. Anthracyclines may be used in children to treat leukemia or solid malignant tumors. The structural damage to the heart occurs in a linear progression and increases with the cumulative dose of the drug. A study was undertaken to determine the cardiac status of long-term survivors of pediatric cancer who had been treated with anthracyclines. A total of 201 patients were assessed; 51 patients had also received radiotherapy to the mediastinum (the organs and tissues within the cavity between the lungs). The patients ranged in age from 2 to 23 years at the end of therapy; half the patients were 10 years or older when they finished treatment. Testing showed abnormal heart function in 23 percent of the study group. There was a significant correlation between total cumulative dose, length of follow-up and mediastinal radiotherapy. Of the patients followed for at least 10 years after receiving an anthracycline dose of 500 milligrams (per square meter of body surface), 63 percent were found to have heart abnormalities. Late symptoms, such as heart failure and abnormal rhythm, were observed in nine patients and three patients died suddenly; autopsies revealed heart muscle abnormalities (fibrosis). The 23 percent rate of late heart abnormalities identified in this study demonstrates that continued evaluation of patients who have received anthracyclines is warranted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Cancer in children, Childhood cancer, Anthracyclines, Heart failure, Heart muscle, Myocardium

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Lymphomatous presentation of childhood acute lymphoblastic leukemia: a subgroup at high risk of early treatment failure

Article Abstract:

One of the features which generally distinguishes lymphomas from leukemia is that lymphomas usually involve one or more detectable masses in the body. However, among children with acute lymphoblastic leukemia (ALL), a minority are diagnosed with masses of abnormal cells which at first glance may resemble lymphomas. An analysis of case records has revealed that the presence of a lymphoma-like mass upon diagnosis is an indicator of poor prognosis for children with this form of leukemia. A total of 2,987 case records were analyzed, although 708 were missing one or more pieces of information significant to the study. It was found that the presentation with a lymphoma-like mass, which has been dubbed 'lymphoma syndrome,' is not a distinct clinical entity, since the other features of the disease were as varied for lymphoma syndrome as they were for other cases of ALL. However, the patients with lymphoma syndrome were more likely to fail to respond to treatment, were more likely to suffer relapse soon after treatment, and were more likely to suffer relapse at sites other than the bone marrow. The presence of lymphoma syndrome remained a statistically significant prognostic indicator after other prognostic factors were accounted for. The six-year survival rate for patients with lymphoma syndrome was 36 percent, in contrast with a 64 percent survival rate for the other ALL patients. These results suggest that children presenting with lymphoma syndrome may be candidates for more aggressive initial therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Lymphoblastic leukemia in children, Acute lymphocytic leukemia

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Diaziquone and 2,2'-anhydro-arabinosyl-5-fluorocytosine for the treatment of children with relapsed or refractory acute nonlymphoblastic leukemia

Article Abstract:

Previous studies have shown that diaziquone, also called aziridinylbenzoquinone or AZQ, has activity against acute nonlymphoblastic leukemia in children with relapses or refractory disease. The compound 2,2'-anhydro-arabinosyl-5-fluorocytosine, or AAFC, has also been shown to possess similar activity; AAFC is similar to cytosine arabinoside (Ara-C), but is not degraded as rapidly inside the body as Ara-C. The combination of AZQ and AAFC was used in the treatment of 30 children with relapsed or refractory acute nonlymphocytic leukemia. Twelve patients receiving a higher dose range suffered severe infectious complications, and three died of aplasia when their bone marrow could not recover sufficiently to replace blood cells. Profound bone marrow toxicity was observed in all patients receiving higher or lower doses of the two agents. Four children achieved a complete response, and an additional two achieved a partial response. These results are no better than those which have been achieved using AZQ alone, indicating that there is nothing gained by administering AZQ and AAFC to children with nonlymphoblastic leukemia. Future research should determine if combining AZQ with other drugs will provide improved efficacy in the treatment of these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Leukemia in children

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