The effect of dexrazoxane on myocardial injury in doxorubicin-treated children with acute lymphoblastic leukemia

The New England Journal of Medicine
S E LipshultzS E Sallan

Abstract

Doxorubicin chemotherapy is very effective in children with acute lymphoblastic leukemia (ALL) but also injures myocardial cells. Dexrazoxane, a free-radical scavenger, may protect the heart from doxorubicin-associated damage. To determine whether dexrazoxane decreases doxorubicin-associated injury of cardiomyocytes, we randomly assigned 101 children with ALL to receive doxorubicin alone (30 mg per square meter of body-surface area every three weeks for 10 doses) and 105 to receive dexrazoxane (300 mg per square meter) followed immediately by doxorubicin. Serial measurements of serum cardiac troponin T were obtained in 76 of 101 patients in the doxorubicin group and 82 of 105 patients in the group given dexrazoxane and doxorubicin. A total of 2377 serum samples (mean, 15.1 samples per patient) were obtained before, during, and after treatment with doxorubicin. Troponin T levels were evaluated in a blinded fashion to determine whether they were elevated (>0.01 ng per milliliter)--the primary end point--or extremely elevated (>0.025 ng per milliliter). Elevations of troponin T occurred in 35 percent of the patients (55 of 158). Patients treated with doxorubicin alone were more likely than those who received dexrazoxane and doxoru...Continue Reading

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Citations

May 23, 2006·Intensive Care Medicine·Elie Azoulay, Benoît Schlemmer
Jan 12, 2011·Pediatric Cardiology·Barry H TrachtenbergSteven E Lipshultz
Aug 21, 2013·Cancer Chemotherapy and Pharmacology·Duncan T VincentYuichiro J Suzuki
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