Do ACE inhibitors help with anthracycline-induced cardiotoxicity in leukemia and lymphoma?

This study aimed to investigate if enalapril influences anthracycline-induced cardiotoxicity in children with leukemia and lymphoma. This study concluded that enalapril has a role in reducing anthracycline-induced cardiotoxicity in these patients.

Anthracyclines are a class of chemotherapy drugs that can be used for cancer. Cardiotoxicity is a common side effect of anthracyclines and other chemotherapies. Cardiotoxicity is damage to the heart muscle which can disturb the pumping of blood around the body. It is thought that other drugs can help reduce anthracycline cardiotoxicity. 

Angiotensin-converting enzyme (ACE) inhibitors are generally used to treat high blood pressure and heart failure. It is still unknown if an ACE inhibitor called enalapril (Vasotec) would influence anthracycline-induced cardiotoxicity in children with leukemia and lymphoma. 

This study involved 84 children who had leukemia or lymphoma. All patients were treated with anthracyclines (doxorubicin and/or daunorubicin). Patients were split into two groups. Group A received enalapril and group received a placebo for 6 months. Left ventricular ejection fraction (LVEF) is a measure of the percentage of blood leaving the heart via the left ventricle (a chamber of the heart) every time the heart contracts. This was measured at 0 and 6 months. Cardiac biomarkers such as proBNP, troponin or CK-MB were also measured at 0 and 6 months. These are released into the blood when the heart is damaged or stressed. 

LVEF decreased in both groups at 6 months but more so in group B. A greater than 20% decrease was seen in 3 patients (8%) in group B but none in group A. 

Cardiac biomarkers increased more in group B at 6 months. In group A, 9.1% of the patients showed an increase in proBNP level compared with 37.5% in group B. No patient developed heart failure or arrhythmia.

This study concluded that enalapril has a role in reducing anthracycline-induced cardiotoxicity in children with leukemia and lymphoma.

This study had a short follow-up of 6 months. Studies of longer duration need to be carried out.

Consult your physician about managing anthracycline-induced toxicity.