Early doxorubicin cardiotoxicity in Malawian children admitted to Queen
Elizabeth Central Hospital, Malawi.
Abstract
Abstract: Background. Doxorubicin chemotherapy drug , use is limited by
it’s potential to cause cardiotoxicity. In resource poor settings, like
Malawi, monitoring of doxorubicin cardiotoxicity is not routinely
conducted in cancer patients and the incidence of doxorubicin
cardiotoxicity is not known. Methods. Children aged 3 months to 18 years
with cancer were prospectively enrolled from the paediatric oncology
ward and followed up from January 2016 to June 2019. Transthoracic
echocardiographic monitoring of left ventricular ejection fraction
(LVEF) was done at baseline, one month, six months and a year after
completion of therapy. Cardiotoxicity was defined as a decline in LVEF
of ≥10% to a final value of <50%, and an overall incidence
risk of developing cardiotoxicity was estimated. A one-way analysis of
variance was conducted to compare baseline LVEF with that measured
during follow up intervals. Findings. A total of 91 children were
enrolled into the study, 74% (68/91) were male, and 67% (62/91) were
aged 5 months to 14 years. Burkitt lymphoma was diagnosed in 41%
(38/91) of the children. No one experienced cardiotoxicity during the
study period. However, of 77 children who had at least one follow up,
five children 6·54% (95% CI: 2.1-14.5) experienced a reduction in LVEF
of >10%, though not to a final value of <50%.
No deterioration of systolic function was found among 20 children who
had completed follow up. (F= 2·43, p-value=0·07). Interpretation. In
this cohort, there were no observed cardiotoxic events associated with
doxorubicin administration as per pre-defined criterion