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Anthracycline cardiotoxicity in long-term survivors of childhood cancer

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Abstract

Anthracycline chemotherapy is a widely-used and effective treatment for a wide spectrum of childhood cancers. Its use is limited by associated progressive and clinically significant cardiotoxic effects. Onset can be acute, early, or late. While acute onset is rare, long-term survivors have significantly elevated rates of cardiac morbidity and mortality. Major complications include cardiomyopathy, coronary artery disease, and atherosclerosis. Means of prevention and treatment continue to be explored including limiting cumulative anthracycline dose, controlling the rate of administration, and using liposomal preparations and novel anthracycline analogues. Dexrazoxane prior to anthracycline chemotherapy has been shown to significantly lower rates of elevated serum cardiac troponin levels, a marker of myocyte injury, indicating a cardioprotective effect. Pilot studies indicate that exercise interventions may also be beneficial in long-term survivors with cardiac damage. Support and study of this population to decrease the morbidity and morality associated with anthracycline-induced cardiotoxicity is indicated in a time sensitive fashion.

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Acknowledgments

This paper has been supported in part by grants from the National Cancer Institute (CA68484-SL, CA34183-SL, CA79060-SL, CA06516-SL), National Heart, Lung, and Blood Institute (HL69800-SL, HL53392-SL, HL59837-SL, HL53392-SL), the Lance Armstrong Foundation (SL), and the Children’s Cardiomyopathy Foundation (SL).

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Clinical Research, University of Miami Miller School of Medicine, Miami, FL, 33101, USA

    Rebecca E. Scully

  2. Department of Pediatrics, Mailman Center for Child Development, UM Miller School of Medicine, 1601 NW 12th Ave, 9th Floor, Miami, FL, 33101, USA

    Steven E. Lipshultz

  3. Holtz Children’s Hospital of the University of Miami/Jackson Memorial Medical Center, Miami, FL, 33101, USA

    Steven E. Lipshultz

  4. Sylvester Comprehensive Cancer Center, Miami, FL, 33101, USA

    Steven E. Lipshultz

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Correspondence to Steven E. Lipshultz.

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Scully, R.E., Lipshultz, S.E. Anthracycline cardiotoxicity in long-term survivors of childhood cancer. Cardiovasc Toxicol 7, 122–128 (2007). https://doi.org/10.1007/s12012-007-0006-4

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