Avilés A, Arévila N, Díaz Maqueo J C, Gómez T, García R, Nambo M J
Department of Hematology, Oncology Hospital, México, D.F. Mexico.
Leuk Lymphoma. 1993 Oct;11(3-4):275-9. doi: 10.3109/10428199309087004.
Cardiotoxicity is a well recognized side effect of anthracyclines (doxorubicin and epirubicin) or antracenadiones (mitoxantrone) at cumulative or high doses. However the side effects have not been evaluated in adults with Hodgkin's disease who received therapeutic doses of these drugs. We analyzed the cardiac function studying the left ventricular ejection fraction (LVEF) at rest in 136 patients with Hodgkin's disease treated with doxorubicin, epirubicin or mitoxantrone used in combination with vinblastine, bleomycin and decarbazine. No other risk factors, such as radiation therapy to the mediastinum, were considered. The follow-up is 5 to 8 years for patients in complete remission. Forty-five patients received doxorubicin (from 325 to 685 mg/m2, median 475 mg/m2), 51 patients received epirubicin (from 310 to 610 mg/m2, median 510 mg/m2) and 40 patients were treated with mitoxantrone (from 70 to 165, median 125 mg/m2). The median time between the end of treatment and the evaluation was 6.7 years. Thirty seven percent of the patients (similar rates in the three groups) showed abnormalities in the LVEF with decreased rates independent of the drug dosage. These were compared with two control groups, 46 patients treated with the MOPP combination (mechlorethamine, vincristine, prednisone and procarbazine) or LOPP (chlorambucil, for mechlorethamine) and 35 healthy volunteers. We believe that the use of anthracyclines or antracenadione will produce late cardiac effects in a fraction of patients independently of the doses used and that the indications for these drugs be carefully monitoring so as to evaluate the development of late side effects.
心脏毒性是蒽环类药物（多柔比星和表柔比星）或蒽二酮类药物（米托蒽醌）在累积剂量或高剂量时公认的副作用。然而，这些副作用在接受治疗剂量这些药物的成人霍奇金病患者中尚未得到评估。我们分析了136例接受多柔比星、表柔比星或米托蒽醌联合长春碱、博来霉素和氮烯咪胺治疗的霍奇金病患者静息状态下的左心室射血分数（LVEF）来研究心脏功能。未考虑其他危险因素，如纵隔放射治疗。完全缓解患者的随访时间为5至8年。45例患者接受多柔比星治疗（剂量为325至685mg/m²，中位数为475mg/m²），51例患者接受表柔比星治疗（剂量为310至610mg/m²，中位数为510mg/m²），40例患者接受米托蒽醌治疗（剂量为70至165，中位数为125mg/m²）。治疗结束至评估的中位时间为6.7年。37%的患者（三组发生率相似）LVEF出现异常，降低率与药物剂量无关。将这些患者与两个对照组进行比较，46例接受MOPP方案（氮芥、长春新碱、泼尼松和丙卡巴肼）或LOPP方案（苯丁酸氮芥替代氮芥）治疗的患者以及35名健康志愿者。我们认为，使用蒽环类药物或蒽二酮类药物将在一部分患者中产生晚期心脏效应，与所用剂量无关，并且应仔细监测这些药物的适应证，以便评估晚期副作用的发生情况。
