|  |  |  | | | | Cardiac Disease After Chemotherapy For Cancer | | | | |
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Release Date: 11 Nov 2008
There have been reports in newspapers and broadcasts of the decision of a teenage girl to refuse a heart transplant, to treat heart disease described as a consequence of treatment for acute myeloid leukaemia (AML). Leukaemia Research does not have any comment on this specific case, other than to offer our best wishes to the young lady and her family.
However, we are concerned that the reports might cause unnecessary anxiety to parents of children being treated for leukaemia. It is known that some drugs (called anthracyclines) used in treatment of childhood leukaemia (both acute lymphoblastic (ALL) and acute myeloid (AML)) can cause long-term heart problems (cardiac disease).
It is very important to stress that only a minority of children treated for AML develop serious heart problems – less than 10% of all children; other children may have milder effects and do not need for any treatment. Thankfully, a case such as the one reported, where it was felt necessary to consider a heart transplant are exceptional.
Based on the medical literature and expert advice, we believe that references in some reports in the media to chemotherapy having “caused” a hole in the heart are likely to be mistaken. Furthermore a hole in the heart would not normally be treated with a heart transplant.
Heart problems associated with leukaemia treatment are usually myopathy – a condition in which the heart muscle is weakened and cannot pump blood around the body efficiently; if this is very severe the patient might be considered for a heart transplant. Carrying out a heart transplant is more complicated in a patient, of any age, who has been treated for acute leukaemia.
The most serious effects from anthracyclines are seen in children with AML because they receive larger doses; and the effects of the drugs are cumulative so do not wear off if the child comes off the drug. The severity of side effects is relates to the total life-time dose received. Children with ALL may have some minor cardiac damage but is often so slight that it can only be detected using very specialized tests and will not affect the child’s normal daily life.
Studies have been carried out, both for ALL and AML, on treatment without anthracyclines, but the result was poorer control of the leukaemia – anthracyclines are particularly effective at killing leukaemia cells. It was decided that the problems arising from not using the drugs were worse than the side effects of the drugs, so they continue to be used.
The main approaches now being used are a reduction in the dosage of anthracyclines to see how low a dose can be given while still being effective, and development of drugs which can block the damage to the heart without affecting the ability of chemotherapy to kill leukaemia cells. A number of drugs are being tested in adults at present to see how well this can be achieved. If proved effective these are likely to be made available for children, but it is not possible to say how long this will take.
In all cases, doctors carefully monitor the heart function of any child being treated for leukaemia and balance the need to treat the leukaemia effectively against any risk of side-effects of treatment.
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