Late anthracycline cardiotoxicity after childhood cancer: a prospective longitudinal study

Cancer. 2003 Apr 15;97(8):1991-8. doi: 10.1002/cncr.11274.


Background: The objective of the current study was to examine the risk factors for progression in severity of anthracycline-induced cardiac dysfunction, thereby providing information that is useful in refining cancer treatment regimes and guiding follow-up.

Methods: Serial echocardiograms were performed on 101 acute lymphoblastic leukemia survivors and 83 Wilms tumor survivors after a mean interval of 6.2 years and 6.7 years since last anthracycline dose, respectively, at first study, and after 10.3 years and 11.1 years, respectively, at second study. The paired data were contrasted with data from 100 normal subjects, and potential correlations with follow-up interval, cumulative dose, cancer diagnosis, gender, age at diagnosis, and growth were explored using univariate and multiple regression techniques.

Results: The most important predictor of worsening cardiac performance was total anthracycline dose. As a group, patients receiving < 240 mg/m(2) showed no deterioration of left ventricular end systolic stress at > 10 years from the end of treatment.

Conclusions: Survivors who have received low-dose anthracycline require cardiac surveillance infrequently. In good prognosis tumors, cumulative anthracycline dose should be maintained at < 250 mg/m(2).

MeSH terms

  • Antibiotics, Antineoplastic / adverse effects*
  • Antibiotics, Antineoplastic / therapeutic use
  • Child, Preschool
  • Cohort Studies
  • Daunorubicin / adverse effects*
  • Daunorubicin / therapeutic use
  • Echocardiography
  • Female
  • Heart / drug effects*
  • Heart Diseases / chemically induced*
  • Heart Diseases / diagnostic imaging
  • Humans
  • Kidney Neoplasms / drug therapy*
  • Longitudinal Studies
  • Male
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Prospective Studies
  • Wilms Tumor / drug therapy*


  • Antibiotics, Antineoplastic
  • Daunorubicin