Cardiac function of survivors of childhood acute lymphoblastic leukemia treated with anthracyclines

This study aimed to investigate the heart function of acute lymphoblastic leukemia survivors who had been treated with anthracyclines. This study concluded that these patients had decreased heart function long after treatment.

Anthracyclines are a type of chemotherapy drug. Examples are daunorubicin (Cerubidine) and doxorubicin (Adriamycin). Anthracyclines can be used for the treatment of childhood acute lymphoblastic leukemia (ALL). However, these drugs are known to produce heart-related side effects that can lead to heart failure.  

Cardiac troponin T is a protein found in heart muscle fibers that regulates muscle contraction. The levels of troponin can be used to detect heart injury. N-terminal-pro-brain natriuretic peptide (NT-pro BNP) blood levels can indicate heart failure. Echocardiography uses sound waves to produce live images of the heart. Strain echocardiography shows a deformation of the heart muscle. A decreased strain is a predictor of heart failure.  

The long-term side effects of anthracycline on the heart function of ALL survivors are still under investigation.

This study involved 41 survivors of childhood ALL. All patients had been treated with anthracyclines. The heart function of these patients was assessed. Heart function was assessed using troponin T and NT-pro BNP levels, conventional 2D strain echocardiography (EC), and myocardial (heart muscle) 2D strain EC. Values were measured before (T=0) treatment, during (T=1), shortly after (T=2; 1 year after treatment), and long after anthracycline treatment (T=3; 5 years or more after treatment).  

None of the survivors showed symptoms of heart failure at T=3. No patients had abnormal troponin levels, while 2 patients had abnormal NT-pro BNP levels.

 At EC, strain values decreased during anthracycline treatment. At T = 1, 38% of survivors had a reduction in strain value. At T = 3, 54% of survivors had a reduction in strain value.

At T = 3, no abnormal cardiac troponin T levels were observed. At T = 3, 6% of survivors showed abnormal N-terminal-pro-brain natriuretic peptide levels. The EC data of the ALL survivors at T=3 were compared to data from similar people without ALL. ALL survivors showed significantly lower conventional and myocardial 2D strain values when compared to healthy age-matched controls.  

This study concluded that ALL survivors treated with anthracyclines showed an ongoing reduction in heart function long after treatment. It was also concluded that early detection of heart side effects before symptoms appear is crucial for intervention and prevention of further progression. 

This study had a small number of participants. Larger studies are needed.

Consult your physician about heart side effects of chemotherapy.