Evaluation of left ventricular function in asymptomatic children about to undergo anthracycline-based chemotherapy for acute leukemia: An outcome study

Background: Cardiac toxicity is a well-recognized potential complication of anthracycline use. Children treated with anthracyclines undergo several ca rdiac screening procedures before therapy. but the usefulness of these pret herapy cardiac studies has never been evaluated. The authors examined wheth er induction chemotherapy in patients with high-risk acute lymphoblastic le ukemia (ALL) was altered based on a pretherapy left ventricular shortening fraction (SF). Patients and Methods: Medical records of 134 children registered on treatme nt protocols of the Pediatric Oncology Group for highrisk B-precursor and T -cell ALL between 1987 and 1998 were reviewed. Demographic information cons isting of age at diagnosis, sex, and past cardiac history was collected, as were the results of all echocardiographic evaluations for SF and actions t aken based on these evaluations. The outcome measured was whether any chang es were made in induction therapy based on initial SF. In addition. seconda ry SF results obtained at the cumulative anthracycline dose range of 90 to 150 mg/m(2) were studied to determine whether modifications of future chemo therapy were made after this limited exposure. Results: Three of 128 children (2.3%) without a previous cardiac history ha d an initial SF on their pretherapy echocardiogram that prompted additional evaluation but no change in therapy. A secondary analysis of SF in 85 chil dren who completed anthracycline doses of 90 to 150 mg/m(2) was performed. There were three (3.5%) with abnormal study results who were evaluated furt her. Again, no changes were made in the anthracycline doses based on these findings. No cardiac dysfunction occurred among these six patients during l ater follow-up. Conclusions: In the absence of a previous cardiac history or signs and symp toms or cardiac disease, pretherapy evaluation of left ventricular function may not be indicated in children about to undergo anthracycline-based trea tment of acute leukemia. The timing of initiation of cardiac evaluation rem ains unclear, but these results suggest that even at a cumulative dose of 9 0 to 150 mg/m(2), studies to determine left ventricular function do not yie ld data sufficient to warrant a change in the clinical management of these patients.