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ASCO Educational Book; 2008
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Detecting Anthracycline-induced Cardiotoxicity in Survivors of Childhood Cancer

Rebecca E. Scully1,2, Tracie L. Miller, MD1,2,3, and Steven E. Lipshultz, MD1,2,3,4

From the 1 Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; 2 Division of Clinical Research, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; 3 Holtz Children's Hospital of the University of Miami/Jackson Memorial Medical Center, Miami, FL; 4 University of Miami Sylvester Comprehensive Cancer Center, Miami, FL

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Steven E. Lipshultz, MD, University of Miami Sylvester Comprehensive Cancer Center, P.O. Box 016820 (D820), Miami, FL 33101; e-mail: slipshultz{at}med.miami.edu

Overview: Anthracycline therapy remains an essential component of treatment for many types of cancer, including acute lymphoblastic leukemia, acute myelogenous leukemia, Hodgkin's disease, and non-Hodgkin's lymphoma. However, doxorubicin and other anthracyclines have been associated with both acute (during therapy) and late (post-therapy) progressive cardiotoxicity, resulting in left ventricular dysfunction and causing cardiomyopathy, congestive heart failure, and death from pump failure or arrhythmia. Thus, detecting myocardial injury at its earliest stages is important in identifying, treating, and preventing cardiotoxicity for long-term survivors of pediatric cancers. A combination of current modalities may offer the most complete picture of the cardiac health of individual survivors. Such monitoring may need to include endomyocardial biopsy, serology, and echocardiography. It is important to note that methods for detecting cardiomyocyte damage are not yet reliable or specific in children, and no cardiac screening method for doxorubicin cardiotoxicity has been validated. Genetic factors and proteomic spectra analysis may represent future directions for monitoring. Nutritional and lifestyle status, especially obesity and metabolic factors, smoking, and low physical activity, affect the risk profile of children at and after cancer diagnosis. Although exercise capacity and safety also must be carefully evaluated for each patient, it is likely that these children would benefit from exercise programs.