An expert opinion on pharmacologic approaches to reducing the cardiotoxicity of childhood acute lymphoblastic leukemia therapies

Patricia Zerra, Thomas R. Cochran, Vivian I. Franco, Steven E Lipshultz

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Introduction: Acute lymphoblastic leukemia (ALL) is the most common hematologic malignancy in children. Treatment-related cardiac damage is progressive and often difficult to reverse. Strategies to minimize cardiotoxicity during treatment are crucial to prevent severe lasting effects on health and quality of life. Areas covered: This comprehensive review covers the pathophysiology and various presentations, both clinical and subclinical, of treatment-induced cardiotoxicity and characteristics associated with increased risk of cardiac dysfunction in childhood ALL survivors. Additionally, contemporary prevention strategies such as limiting cumulative anthracycline dose, altering drug administration schedule, the use of anthracycline structural analogs, liposomal encapsulated anthracyclines, cardioprotective agents and nutritional supplements are critically analyzed. Finally, this review covers the management options of chemotherapy-induced damage and other treatment-related cardiotoxicity. Expert opinion: Higher lifetime cumulative doses of anthracyclines, younger age at diagnosis, longer follow-up, female sex, higher dose rates and cranial irradiation are associated with more severe cardiotoxic effects. Long-term adverse effects of both anthracycline and non-anthracycline chemotherapeutic agents are becoming an increasing focus during treatment of childhood malignancies. There must be a careful balance between achieving remission of childhood ALL while avoiding the development of another often-fatal illness, heart failure.

Original languageEnglish
Pages (from-to)1497-1513
Number of pages17
JournalExpert Opinion on Pharmacotherapy
Volume14
Issue number11
DOIs
StatePublished - Aug 1 2013

Fingerprint

Anthracyclines
Expert Testimony
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Drug Administration Schedule
Cranial Irradiation
Cardiotonic Agents
Therapeutics
Hematologic Neoplasms
Survivors
Heart Failure
Quality of Life
Cardiotoxicity
Drug Therapy
Health
Neoplasms

Keywords

  • Acute lymphoblastic leukemia
  • Anthracyclines
  • Cardiotoxicity
  • Childhood cancer
  • Prevention
  • Survivorship

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

An expert opinion on pharmacologic approaches to reducing the cardiotoxicity of childhood acute lymphoblastic leukemia therapies. / Zerra, Patricia; Cochran, Thomas R.; Franco, Vivian I.; Lipshultz, Steven E.

In: Expert Opinion on Pharmacotherapy, Vol. 14, No. 11, 01.08.2013, p. 1497-1513.

Research output: Contribution to journalArticle

Zerra, Patricia ; Cochran, Thomas R. ; Franco, Vivian I. ; Lipshultz, Steven E. / An expert opinion on pharmacologic approaches to reducing the cardiotoxicity of childhood acute lymphoblastic leukemia therapies. In: Expert Opinion on Pharmacotherapy. 2013 ; Vol. 14, No. 11. pp. 1497-1513.
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