Frequency and risk factors of anthracycline-induced clinical heart failure in children: a systematic review

• Published in: Annals of oncology Vol. 13; no. 4; pp. 503 - 512
• Main Authors: Kremer, L. C. M., van Dalen, E. C., Offringa, M., Voûte, P. A.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2002
• Subjects: Adolescent; Adult; Antibiotics, Antineoplastic - administration & dosage; Antibiotics, Antineoplastic - adverse effects; Antibiotics, Antineoplastic - therapeutic use; Biological and medical sciences; cardiotoxicity; Cardiovascular Diseases - chemically induced; Child; Child, Preschool; children; Dose-Response Relationship, Drug; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Drug toxicity and drugs side effects treatment; Female; Forecasting; heart failure; Humans; Infant; Infant, Newborn; Key words: anthracycline; Male; Medical sciences; Neoplasms - drug therapy; Pharmacology. Drug treatments; Risk Factors; systematic review; Toxicity: cardiovascular system; Antineoplastic agent; Heart; Human; Heart failure; Occurrence frequency; Toxicity; Cardiovascular disease; Malignant tumor; Chemotherapy; Treatment; Heart disease; Risk factor; Predisposition; Anthracyclins; Child
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdf118

Background Anthracyclines are essential for the treatment of the children with cancer. We performed a systematic review to evaluate the existing evidence of the frequency and risk factors of anthracycline-induced clinical heart failure (A-CHF) in children. Design Medline was searched for articles reporting the frequency of A-CHF, published from 1966 to December 2000. Information about study features, risk factors and frequency were abstracted, and a validity score was given for each study. The potential predictive factors of A-CHF were analysed both within and across the studies. Results The frequency of A-CHF in children was estimated in 30 studies described in 25 articles. All studies have serious methodological limitations. The frequency varied between 0% and 16%. In the analysis across the studies the type of anthracyclines and the maximal dose in 1 week explain a considerable part of the variation of the frequency of A-CHF. Conclusions Doxorubicin and a dose above 45 mg/m2 within 1 week seemed to increase the frequency of A-CHF. Well designed and executed studies are needed to accurately estimate the frequency of A-CHF and reliably assess the importance of potential risk factors.