Cumulative Dose of Anthracycline and Cardiotoxicity in Patients with Hematologic Malignancy

Anthracycline (AC) induced cardiotoxicity is a dose limiting factor in anti-cancer chemotherapy including AC.It has been reported that AC induced cardiotoxicity increases when the cumulative dose exceeds 500 mg/m2 (calculated as doxorubicin).In view of this,we investigated accumulation rates in 59 patients with hematological malignancies,and estimated the time taken for it to reach 500 mg/m2 for the 3 major regimens of high-CHOP,CHOP and VAD,to Compare the differences between predicted values calculated from the initial dose of AC for each regimen.The relationship between the cumulative dose of AC and cardiotoxicity for several chemotherapies including AC was also investigated.The accumulation rate of AC was 1.37 (0.17-3.14)mg/m2/day and the cumulative dose of 500 mg/m2 would be reached 170,231 and 495 days after starting high-CHOP,CHOP and VAD,respectively,which was 10-27% longer than the times predicted on the basis of the initial dose of AC for each regimen.A positive correlation was found between electrocardiographic QTc and cumulative dose of AC (r=0.448,p<0.05).As two of five patients in whom the cumulative dose reached 500 mg/m2 of AC developed cardiomyopathy,AC cardiotoxicity should be intensively monitored 170-495 days after starting the chemotherapies such as high-CHOP,CHOP and VAD,when the cumulative dose is approaching 500 mg/m2.