Daunomycin-Related Cardiomyopathy in Children and Adolescents with Improved Acute Lymphoblastic Leukemia and its Relationship with Cardiac Troponin-T Levels

This study was done to determine the frequency of cardiomyopathy related to Daunomycin in children and adolescents with improved acute lymphoblastic leukemia and its relationship with cardiac troponin-T and cumulative dose of drug. This cross sectional study was conducted on children and adolescents under age 18 years with improved acute lymphocytic leukemia disease (ALL) and a history of receiving daunomycin who referred to Al-zahra hospital, Iran. People with inclusion criteria based on cumulative dose of daunomycin were divided into two groups. First group of patients were those who received cumulative daunomycin dose fewer than 250 mg/m2 and second group with cumulative dose equal to or greater than 250 mg/m2. In all patients after obtaining consent and taking history, blood levels of cardiac-troponin-T and Shortening Fraction (FS) and Ejection Fraction (EF) indices was measured. Collected data was analyzed by SPSS. Among 55 patients treated with daunomycin, three patients were diagnosed with cardiomyopathy, all of which were in the second group (P < 0.048). The mean EF in the first group and second group were respectively 65.03+4.26 and 61.4+6.56 (P < 0.02). The mean SF in the first and second group were respectively 34.23+4.19 and 31.92+4 (P < 0.04). Cardiac troponin-T test result was positive in 4 patients from the second group but in the first group there were no positive tests (P < 0.037). There was no significant relationship between cardiomyopathy and increased level of cardiac troponin-T (P = 0.21). Acute lymphocytic leukemia patients treated with daunomycin were at risk for cardiac complications. It is recommended to avoid therapy with a dose more than 250 mg/m2. Since there was not any correlation between cardiac troponin-T level and cardiomyopathy, cardiac troponin-T can not be a reliable marker of delayed cardiotoxicity.