Bauters F, Plouvier B, Breviere G, Goudemand M
Sem Hop. 1975 Jun 14;51(28):1949-57.
Out of a total of 126 patients with acute lymphoblastic leukemia, including 69 children aged less than 15 years, and 57 adults aged less than 60 years, who were treated with daunomycin (D.N.R.) initially and with several courses of reinduction, we noted 4 cases of decompensated heart failure (3.1%). 3 cases occurred in children aged 4, 5 and 5 years, and in the last case, in a young adult, of 19 years. Three of these patients were in complete remission of the blood and were only undergoing courses of reinduction. The 4th was in incomplete remission. When symptoms first occurred, about 2 months after the last injection of D.N.R. the total dose administered varied between 14 and 31 mg/kg, extending over periods of 5 to 16 months (average monthly dose 1.9 to 2.8 mg/kg). Except in one case, the course only mildly influenced by the symptomatic treatment and death occurred in 3 patients within from 15 days to 5 months after the onset of the first symptoms. The last patient is still alive and seems stabilised with a follow up period of 9 months. The responsibility of D.N.R. in the development of this myocarditis appears very likely. The unforeseable character of such complications, which are independent of age, and not necessarily linked to any excessive dosage, should be taken into consideration in the indications for D.N.R. in spite of their relative rarity.
在总共126例急性淋巴细胞白血病患者中，包括69名15岁以下儿童和57名60岁以下成人，这些患者最初接受柔红霉素（D.N.R.）治疗并进行了几个疗程的再诱导治疗，我们注意到4例失代偿性心力衰竭（3.1%）。3例发生在4岁、5岁和5岁的儿童中，最后1例发生在19岁的年轻成人中。其中3例患者血液完全缓解，仅在接受再诱导疗程。第4例处于不完全缓解状态。症状首次出现时，约在最后一次注射D.N.R.后2个月，给药总剂量在14至31mg/kg之间，持续5至16个月（平均每月剂量1.9至2.8mg/kg）。除1例患者外，病程仅受到对症治疗的轻微影响，3例患者在首次症状出现后15天至5个月内死亡。最后1例患者仍然存活，随访9个月似乎病情稳定。D.N.R.在这种心肌炎发生中的责任似乎很大。尽管这些并发症相对罕见，但由于其不可预测的特性，与年龄无关，也不一定与任何过量用药有关，因此在D.N.R.的用药指征中应予以考虑。
