Prospective longitudinal evaluation of doxorubicin-induced cardiomyopathy in sarcoma patients:: A report of the Late Effects Surveillance System (LESS)

Background. Prospective longitudinal examinations of anthracycline-induced cardiomyopathy in a homogeneous cohort are rare in pediatric oncology. We herein report the results of observations on the frequency of cardiomyopathy in doxorubicin-treated sarcorna patients in Germany, Austria, and Switzerland. Procedure. The Late Effects Surveillance System (LESS) prospectively collects longitudinal data on late sequelae of antineoplastic therapy in Ewing-, Soft tissue-, and osteosarcoma patients treated within the therapy trial protocols of the German Society of Pediatric Oncology and Hematology. Two hundred sixty-five relapse-free patients who had received doxorubicin for the treatment within the EICESS-92/EU RO-E.W.I. N.G.99, COSS-96, and CWS-96 therapy trials were serially examined by echocardiography. The analyzed Population consisted of 142 males and 123 females. Their rnean age at the end of therapy was 13 5 years. The mean follow-up time was 34 12 months. The mean cumulative doxorubicin dose was 290 +/- 91 mg/m(2). Results. In this cohort, the total cumulative incidence of doxorubicin-induced cardiomyopathy was 7.5%. Four patients 0.5%) suffered from a symptomatic cardiomyopathy and 16 (6%) from a subdinical carcliomyopathy. Cardiomyopathy manifested in 11 cases already under antineoplastic therapy and in the remaining nine cases at a median of 26 days (range: 17-174 days) after stopping antineoplastic therapy. Univariate and multivariable analysis did not confirm any of the known risk factors for developing anthracycline-induced cardiomyopathy in our patient group within the described time interval. Conclusions. After a mean follow-up of 34 12 months, cumulative incidence of doxorubicin-induced cardiomyopathy in our pediatric sarcoma patients was at the lower end of that reported by other groups. Pediatr Blood Cancer 2006;46:489-495. (c) 2005 Wiley-Liss, Inc.