Low-dose daunorubicin in induction treatment of childhood acute lymphoblastic leukemia: No long-term cardiac damage in a randomized study of the Dutch Childhood Leukemia Study Group

Background. To investigate late cardiotoxicity in childhood acute lymphobla stic leukemia (ALL) survivors after induction treatment with or without dau norubicin (DNR; 25 mg/m(2), i.v., weekly, x4, cumulative dose 100 mg/m(2)). Procedure, Cardiac function was assessed in 90 event-free survivors of chi ldhood ALL, 11.4-17.8 years (median 14.8 years) after treatment according t o the DCLSG protocol ALL V. In this protocol patients were randomized to re ceive (group B) or not to receive (group A) DNR 25 mg/m(2)/week i.v. during the first 4 weeks of induction treatment. Age at diagnosis was 1.2-14.9 ye ars (median 4.5 years). The cardiac evaluation consisted of a history, phys ical examination, electrocardiogram (ECC), 24 hr ambulatory EGG, and echoca rdiography. Results. Electrocardiographic data, arrhythmias, left ventricul ar dimensions, left ventricular contractility, wall stress, and diastolic f unction were within normal limits in both groups. No difference could be sh own between data from group A (n = 40) and group B (n = 50). Conclusions. N o late cardiac damage was demonstrated in childhood ALL survivors after ind uction treatment including a cumulative dose of 100 mg/m(2) DNR, compared t o survivors who received the same treatment but without DNR. DNR 100 mg/m(2 ) given in 4 doses of 25 mg/m(2)/week appears to be a safe dose in inductio n treatment of ALL. 2000 Wiley-Liss, Inc.