SUPPORTIVE CARE OF CHILDREN WITH CANCER: MONITORING PATIENTS RECEIVING ANTHRACYCLINES (BACKGROUND)

A.     The anthracycline antibiotics can cause both acute and long

term cumulative cardiotoxic effects. Anatomic damage

increases linearly with the cumulative dose, whereas clinical

manifestations increase more logarithmically at higher

doses.

B.     The incidence of clinical cardiotoxicity can be anticipated to

increase rapidly beyond a cumulative dose of about 450

mg/m2 for both doxorubicin and daunorubicin and 125

mg/m2 for idarubicin.

C.     Individual patients may have a lower threshold and develop

toxicity at significantly lower doses.

D.     Mediastinal irradiation increases both anatomic and clinical

toxicity at any cumulative dose.

E.     Cardiac dysfunction may appear several months after

anthracycline therapy, and cardiac status during the year

after treatment predicts long-term effects. Therefore, con-

tinue monitoring after drug discontinuation.

F. In calculating the maximum allowable dose of anthracy-clines, consider the possibility of the future administration of other cardiotoxic drugs (e.g., high-dose cyclophosphamide), mediastinal radiation, or bone marrow transplantation.

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Cancer