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Early doxorubicin cardiotoxicity in Malawian children admitted to Queen Elizabeth Central Hospital, Malawi
Author(s) -
Moyo Dominic,
Chimalizeni Yamikani,
Chagaluka George,
Banda Clifford G.,
Molyneux Elizabeth M.
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.29003
Subject(s) - cardiotoxicity , medicine , ejection fraction , doxorubicin , incidence (geometry) , cumulative dose , cohort , cumulative incidence , pediatrics , chemotherapy , heart failure , physics , optics
Background Doxorubicin is known to cause chemotherapy‐induced cardiotoxicity. In resource‐poor settings, monitoring for cardiotoxicity is not routinely done, and its incidence is unknown. The aim of this study was to determine the proportion of children who developed doxorubicin‐induced cardiotoxicity within 1 year of having received treatment at paediatric oncology ward. Methods Children aged 3 months to 18 years with cancer were prospectively enrolled and followed up between January 2016 to June 2019. Transthoracic echocardiogram was done at baseline, 1 month, 6 months and a year after completion of therapy. Cardiotoxicity was defined as a decline in left ventricular ejection fraction (LVEF) of ≥10% to a final value of <50%. An overall incidence risk of developing cardiotoxicity was estimated. A one‐way analysis of variance (ANOVA) was conducted to compare baseline LVEF with follow‐up measurements. Findings Ninety‐one children were enrolled, 74% (68/91) were male, and 67% (62/91) were aged 5 months to 14 years. Most patients received a doxorubicin cumulative dose between 100 and 200 mg/m 2 and no cardiotoxicity was observed during the study period. However, of 77 children with at least one follow up, five children 6.54% (95% CI: 2.1–14.5) experienced LVEF reduction of >10%, though not to a final value of <50%. No deterioration of systolic function was found among 20 children who completed follow‐up ( F = 2.43, p ‐value = .07). Interpretation In this cohort of patients, most received a low cumulative doxorubicin dose and only 22% were available for evaluation at study end; no cardiotoxic events associated with doxorubicin administration were observed after 12 months.