SUPPORTIVE CARE OF CHILDREN WITH CANCER: MONITORING PATIENTS RECEIVING ANTHRACYCLINES (BACKGROUND)
A. The anthracycline antibiotics can cause both acute and long
term cumulative cardiotoxic effects. Anatomic damage
increases linearly with the cumulative dose, whereas clinical
manifestations increase more logarithmically at higher
B. The incidence of clinical cardiotoxicity can be anticipated to
increase rapidly beyond a cumulative dose of about 450
mg/m2 for both doxorubicin and daunorubicin and 125
mg/m2 for idarubicin.
C. Individual patients may have a lower threshold and develop
toxicity at significantly lower doses.
D. Mediastinal irradiation increases both anatomic and clinical
toxicity at any cumulative dose.
E. Cardiac dysfunction may appear several months after
anthracycline therapy, and cardiac status during the year
after treatment predicts long-term effects. Therefore, con-
tinue monitoring after drug discontinuation.
F. In calculating the maximum allowable dose of anthracy-clines, consider the possibility of the future administration of other cardiotoxic drugs (e.g., high-dose cyclophosphamide), mediastinal radiation, or bone marrow transplantation.