Clinical cardiotoxicity following anthracycline treatment for childhood cancer: The Pediatric Oncology Group experience
Clinical cardiotoxicity following anthracycline treatment for childhood cancer: The Pediatric Oncology Group experience
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DOI：
10.1200/jco.1997.15.4.1544
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发表时间：
1997-04-01
影响因子：
45.3
通讯作者：
Lipshultz, SE
中科院分区：
文献类型：
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作者：
Krischer, JP;Epstein, S;Lipshultz, SE
目的：确定癌症儿童蒽环类化疗临床心脏毒性的发生率，并确定相关危险因素。患者和方法：研究人群包括 6,493 名癌症儿童，他们在 1974 年至 1990 年间按照儿科肿瘤学组 (POG) 方案接受过蒽环类化疗。心脏毒性，定义为非其他原因引起的充血性心力衰竭、促使停止治疗的心功能异常测量或猝死结果：106 名患者 (1.6%) 确认有心脏毒性：58 名患者患有充血性心力衰竭，43 名患者的心功能指标发生变化，导致停止治疗，5 名患者因假定的心脏原因突然死亡。在多变量分析中，导致毒性相对风险（RR）的因素包括累积蒽环类药物剂量大于或等于体表面积550 mg/m(2)（RR = 5.2）、最大剂量大于或等于50 mg/m（2）（RR = 2.8）、女性（RR = 1.9）、黑人种族（RR = 1.7）、存在21三体（RR = 3.4），以及暴露于安吖啶（RR = 2.6）。蒽环类药物治疗完成后1年内的心脏毒性（早期心脏毒性）占所有病例的89.5%。结论：接受蒽环类药物治疗的儿童早期临床心脏毒性很少见。蒽环类药物最大剂量或累积剂量高、女性、黑人种族、21三体的存在以及安吖啶治疗会增加蒽环类药物相关心脏毒性的风险。 (C) 1997 年，美国临床肿瘤学会。
Purpose: To determine the incidence of clinical cardiotoxicity from anthracycline chemotherapy in children with cancer and to identify associated risk factors.Patients and Methods: The study population consisted of 6,493 children with cancer who had received anthracycline chemotherapy on pediatric Oncology Group (POG) protocols from 1974 to 1990. Cardiotoxicity, defined as congestive heart failure not due to other causes, abnormal measurements of cardiac function that prompted discontinuation of therapy, or sudden death from presumed cardiac causes, was determined by a review of protocol records.Results: Cardiotoxicity was confirmed in 106 patients (1.6%): 58 had congestive heart failure, 43 had changes in measures of cardiac function that prompted the discontinuation of therapy, and five died suddenly From presumed cardiac causes. In a multivariate analysis, factors that contributed to the relative risk (RR) of toxicity were a cumulative anthracycline dose greater than or equal to 550 mg/m(2) of body-surface area (RR = 5.2), maximal dose greater than or equal to 50 mg/m(2) (RR = 2.8), female sex (RR = 1.9), black race (RR = 1.7), presence of trisomy 21 (RR = 3.4), and exposure to amsacrine (RR = 2.6). Cardiotoxicity within I year after the completion of anthracycline treatment (early cardiotoxicity) represented 89.5% of all cases.Conclusion: Early clinical cardiotoxicity in children treated with anthracycline is rare. A high maximal dose, or cumulative dose of anthracycline, female sex, black race, presence of trisomy 21, and treatment with amsacrine increase the risk for anthracycline-associated cardiotoxicity. (C) 1997 by American Society of Clinical Oncology.