One-Year Study of Clinical Cardiotoxicity Follows Anthracyclin Treatment in Childhood Malignancy at Benghazi Children Hospital

Abstract

Background: Treatment of pediatric malignancy has greatly improved and survival according to SEER data, mortality rate declined by 40 percent between 1975 and 1995. This declined in mortality has accompanied by increase in the recognition of long term side effect from treatment of childhood cancer, one of major complication is cardiac, during or after administration of anthracyclin patient can develop acute cardiac toxicity. Aim: To determine the incidence of clinical cardiotoxicity from anthracycline chemotherapy in children with cancer and to identify risk factors. Material and Method: One-year study (2021) to children with cancer were received anthracycline as part of chemotherapy at Children Hospital Benghazi. Results: During the study period one year (Jan.2021- Dec. 2021) 51 cases received anthracyclin as part of chemotherapy were evaluated with echocardiography there is male predominance represented 62.7% & females37.3%, M: F 1.6:1, Age range from 5 months to 14 years, the commonest age group 1-5 years around 25cases represented 49%, Most cases evaluated in our study diagnosed with Acute Lymphoblastic Leukemia (ALL) 24 cases represented 47.1%, 9 cases with Acute Myeloid Leukemia (AML) 17%, Lymphoma 7 cases represented 13,7%, wilm’s tumor 5 cases 9.8%, neuroblastoma 3 cases 5.8%, Each of Retinoblastoma, adrenocortical carcinoma and hepatoblastoma 1 case (2%), 34 cases were evaluated still on treatment 66.7%, 17 cases 33.3% were finished treatment on follow up 29 cases were received treatment for less than or equal to one year represented to 56.9%, while 22 cases 43.1% >1year, We were divided the patient according to type of anthracyclin (Adriamycin or douanomycin) results show those received Adriamycin only 39.2%, cases were received douanomycin 7.8%, while cases received both of them 53%, 35.9 % of cases received total doses between 201-250 mg\ S.A of anthracyclin, 25 cases 32.1% were received less than 100 mg\S. A, Echocardiography finding were normal in 47 cases represented 92.2%, Acute dilated cardiomyopathy (DCM) noted in 1.9%, was improved with treatment reversible, 3 cases with chronic dilated cardiomyopathy represented 5.9%, these 3 cases need treatment and follow up cardiac clinic for long life, 2 cases with trisomy 21 represented 4%, received anthracyclin chemotherapy without complication, 2 cases have congenital heart disease (4%) one has patent ductus arteriosus (PDA), 2nd ventricular septal defect (VSD), Both of them received anthracyclin chemotherapy without complication, When we compare cases that develop cardiac complications with age 1 case below one year, 2 cases between 6 – 10 years, 1 case more than 10 years of age, 4 cases with cardiac complication 3 cases were males, 1 case was female, 4 cases with cardiac complication 3 were males,1female. When compare result of Echo with type of drugs if child was received Adriamycin, duanomycin or both of them, with duanomycin only 1 had cardiac toxicity, with adriamycin 1 had cardiac toxicity, 27 patients were received both types of anthracyclin 2 patients get cardiac complications 7.8%. Conclusion: Our study proven anthracyclin is cardio toxic drugs especially in young age group, no mortality in our study, but anthracyclin causing morbidity, No differences between males and females. Keywords: pediatric malignancy, Acute Myeloid Leukemia (AML), patent ductus arteriosus (PDA), anthracyclin chemotherapy, Echocardiography.