Low-dose anthracyclines in childhood Acute Lymphoblastic Leukemia (ALL): no cardiac deterioration more than 20 years post-treatment

Introduction In children with cancer a well-known risk factor for cardiotoxicity is a high cumulative dose of anthracyclines, but little is known about cardiac function in low-dose anthracycline-treated survivors. Also, it is unclear if a safe anthracycline-dose exists at all. Patients and methods Cardiac function was assessed in 23 long-term ALL-survivors with a median follow-up of 22 years (range 19.5–24.5) post-treatment. Age at diagnosis and current age were 5.0 (2.0–14.0) and 29.0 (24.0–39.0) years. All 23 survivors were treated according to DCLSG protocol ALL-5, including 18–25 Gy cranial irradiation. Thirteen of them received 4 × 25 mg/m 2 daunorubicin by randomization. Cardiac evaluation included blood pressure measurement, echocardiography, and (24 h-) electrocardiogram. Results were compared with an earlier assessment at median 12 years post-treatment. Results None of the survivors had cardiac abnormalities. Cardiac status of daunorubicin-treated survivors showed no deterioration compared with the previous assessment in 1995. Conclusion and implication for cancer survivors After prolonged follow-up (more than 20 years post-treatment), ALL-survivors treated with low dose daunorubicin had no clinical relevant deterioration of cardiac function.