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Three cases of late-onset anthracycline-related cardiomyopathy due to chemotherapies for hematological malignancy

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Abstract

Background

Although anthracycline-related cardiomyopathy is a life-threatening complication during intensive treatment for hematological malignancies, clinical features and outcomes of this type of cardiomyopathy have been unclear because of limited reports in the literature.

Methods

We analyzed three cases of anthracycline-related cardiomyopathy among 996 patients with either acute myelogenous leukemia (285), acute lymphoblastic leukemia (37), or malignant lymphoma (674) at our hospital during the period from 2006 to 2016.

Results

All patients showed accumulation of anthracycline within a proper range (< 500 mg/sqm). Two patients (Hodgkin lymphoma and acute lymphoblastic leukemia) showed acute heart failure (AHF) with ejection fraction (EF) of 30 and 40% after 4.5 and 5 years after diagnosis, respectively. For AHF, diuretics and carperitide were administered to control in–out balance. The remaining patient (follicular lymphoma) showed ventricular fibrillation (VF)/ventricular tachycardia (VT) with EF of 40% at 5 years after diagnosis. In this patient, immediate cardioversion made VF/VT to normal sinus rhythm, and then, amiodarone was given. Furthermore, implantable cardioverter defibrillator was set up for VF/VT. In all patients, β blocker and/or angiotensin-converting enzyme inhibitor (ACE-I) were administrated to prevent recurrence of anthracycline-related cardiomyopathy. Consequently, two of three patients showed mild improvement of cardiac function.

Conclusion

Our study indicates that late-onset (4 to 5 years) anthracycline-related cardiomyopathy can develop, though range of anthracycline accumulation is in proper range. Thus, a cautious follow-up by ECG and UCG is required. Furthermore, the early treatment after the onset of anthracycline-related cardiomyopathy should be also needed to improve the poor outcome.

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Acknowledgements

We thank the medical and nursing staff who cared for the patients. We are grateful to Mr. Nakamae for the precious suggestions on the case.

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Author notes

  1. Noriaki Kawano and Sayaka Kawano have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, 880-8510, Japan

    Noriaki Kawano, Sayaka Kawano, Shuro Yoshida, Takuro Kuriyama, Taro Tochigi, Takashi Nakaike, Tomonori Shimokawa, Kiyoshi Yamashita, Koichi Mashiba & Ikuo Kikuchi

  2. Trauma and Critical Care Center, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Hidenobu Ochiai

  3. Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Kazuya Shimoda

Authors
  1. Noriaki Kawano
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  2. Sayaka Kawano
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  3. Shuro Yoshida
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  4. Takuro Kuriyama
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  6. Takashi Nakaike
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  7. Tomonori Shimokawa
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  8. Kiyoshi Yamashita
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  9. Hidenobu Ochiai
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  10. Kazuya Shimoda
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  11. Koichi Mashiba
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  12. Ikuo Kikuchi
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Corresponding author

Correspondence to Noriaki Kawano.

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Conflict of interest

Noriaki Kawano, Sayaka Kawano, Shuro Yoshida, Takuro Kuriyama, Taro Tochigi, Takashi Nakaike, Tomonori Shimokawa, Kiyoshi Yamashita, Hidenobu Ochiai, Kazuya Shimoda, Koichi Mashiba and Ikuo Kikuchi declare that they have no conflict of interest (COI).

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients for this study.

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Kawano, N., Kawano, S., Yoshida, S. et al. Three cases of late-onset anthracycline-related cardiomyopathy due to chemotherapies for hematological malignancy. J Echocardiogr 19, 45–52 (2021). https://doi.org/10.1007/s12574-020-00484-8

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  • DOI: https://doi.org/10.1007/s12574-020-00484-8

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