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Hellenic J Cardiol. 2018 Sep 29. pii: S1109-9666(18)30299-9. doi: 10.1016/j.hjc.2018.09.004. [Epub ahead of print]

Late-onset cardiomyopathy among survivors of childhood lymphoma treated with anthracyclines: a systematic review.

Author information

1
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: benetoud@yahoo.com.
2
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
3
Department of Pediatric Hematology-Oncology, "Pan. &Agl. Kyriakou" Children's Hospital, Athens, Greece.
4
Department of Pediatric Cardiology, XMSK & Merkezi Hospital, National Medical University and the "Aziz Aliyev" National Postgraduate and CME Medical Training Center, Baku, Azerbaijan.
5
1(st) Department of Cardiology, Athens University Medical School, "Hippokration" Hospital, Athens, Greece.
6
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Unit of Clinical Epidemiology, Medical School, Karolinska Institute, Stockholm, Sweden.

Abstract

Medical advances in pediatric oncology have led to increases in survival but the long-term adverse effects of treatment in childhood cancer survivors have not yet been examined in depth. In this systematic review, we aimed to study the prevalence and risk factors of late-onset cardiomyopathy (LOCM) among survivors of childhood lymphoma treated with anthracyclines. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines we searched Pubmed/Medline, abstracted data and rated studies on quality regarding late-onset (>1 year following treatment) cardiotoxicity of anthracyclines in survivors of childhood lymphoma. Across 22 identified studies, the prevalence of anthracycline-induced LOCM among survivors of childhood lymphoma ranges from 0 to 40%. Anthracycline dose, administration and dose of mediastinal radiation, patient's age and era of diagnosis and evaluation, follow-up duration as well as disease relapse have been reported as risk factors for LOCM, whereas administration of dexrazoxane seems to act protectively. There was significant between-study heterogeneity with regards to lymphoma subtypes, follow-up duration, definition of outcomes, and anthracycline-based treatment protocols. The rates of anthracycline-induced LOCM among survivors of childhood lymphoma are high and dependent on study design. Future studies should explore whether modifying risk factors and suggested supportive care could decrease its prevalence among childhood lymphoma survivors. Until then, lifelong follow-up of these patients aiming to determinate the earliest signs of cardiac dysfunction is the most important measure towards primordial prevention of LOCM.

KEYWORDS:

Anthracyclines; Cardiomyopathy; Cardiotoxicity; Childhood Lymphoma; Hodgkin Disease; Non-Hodgkin

PMID:
30273645
DOI:
10.1016/j.hjc.2018.09.004
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