Evaluation Of Anthracycline Related Cardiotoxicity In Pediatric Patients With Acute Leukemia

Objective: The major problem in the long term follow up of children who survive acute leukemia is chemotherapy related organ toxicity. Anthracycline related cardiotoxicity is one of the most important cause of morbidity and mortality for those patients. Therefore, we investigate echocardiographic (echo) data for the detection of acute, early and late anthracycline toxicity in patients with acute leukemia, who were diagnosed and treated in our clinic over the last decade.Method: Echocardiographic data and risk factors of 21 acute myeloid leukemia (AML) patients treated with MRC-12 protocol and 80 acute lymphoid leukemia (ALL) patients treated with BFM-95 protocol were recorded before chemotherapy (TO) and within 3-6 months (T1), 6-12 months (T2), 12-24 months (T3) of treatment and after 24 months (T4) of treatment in our study.Results: We did not observe acute cardiac toxicity in any cases. The values of mitral E/A-velocity (vel) and tricuspid E/A vel were significantly lower in patients with leukemia in T2 than in control (p<0.05). The values of mitral E/A-vel, tricuspid E/A vel, ejection fraction and fractional shortening were significantly lower in patients with leukemia in T3 than in control and in TO (p<0.05). It has been found that 10-15% of all patients who developed cardiac toxicity on long term follow-up were anthracycline exposure at a dose of more than 550 mg/m(2) and relapsed AML cases.Conclusion: Our study suggests that the standard echocardiographic examination used in the toxicity grading is still cheap and noninvasive test which may be preferred in the first place in the long term follow-up of acute leukemia patients.