Beneficial and harmful effects of anthracyclines in the treatment of childhood acute lymphoblastic leukaemia: a systematic review and meta‐analysis
Open Access
- 6 April 2009
- journal article
- research article
- Published by Wiley in British Journal of Haematology
- Vol. 145 (3), 376-388
- https://doi.org/10.1111/j.1365-2141.2009.07624.x
Abstract
Summary: Anthracyclines are used to treat childhood acute lymphoblastic leukaemia (ALL) but non‐randomized studies suggest that cardiotoxicity may be a problem. Individual patient data from trials in childhood ALL that randomized anthracyclines or methods of reducing cardiotoxicity were analysed by standard meta‐analysis methods. Results were grouped and combined according to: addition of an anthracycline to standard therapy, type of anthracycline, mode of administration, and the use of a cardioprotectant. Data from 958 patients in 4 trials, recruiting between 1972 and 1984, showed that addition of an anthracycline reduced bone marrow relapse and, non‐significantly, non‐bone marrow relapse, resulting in an increased relapse‐free interval. However there was a non‐significant increase in induction failures, and in deaths in first remission. Event‐free survival at 5 years was 56·7% with anthracycline versus 52·8% without (Odds Ratio = 0·91; 95% Confidence Interval = 0·76–1·10; P = 0·3). There were no significant differences found in other treatment comparisons. The limited data from trials did not demonstrate differences in clinically evident cardiotoxicity. Anthracyclines are effective against bone marrow relapse but have not been shown to significantly increase event free survival in childhood ALL. The evidence on type of anthracycline, method of administration or use of cardioprotectant was insufficient to be able to rule out important differences.Keywords
This publication has 29 references indexed in Scilit:
- Daunorubicin-Induced Cell Kill with 1-Hour Versus 24-Hour Infusions: A Randomized Comparison in Children with Newly Diagnosed Acute Lymphoblastic LeukemiaKlinische Padiatrie, 2007
- Clinical and cost-effectiveness of cardioprotection against the toxic effects of anthracyclines given to children with cancer: a systematic reviewBritish Journal of Cancer, 2007
- Clinical heart failure in a cohort of children treated with anthracyclines: A long-term follow-up studyEuropean Journal Of Cancer, 2006
- Different anthracycline derivates for reducing cardiotoxicity in cancer patientsPublished by Wiley ,2006
- Exposure to Anthracyclines During Childhood Causes Cardiac InjurySeminars in Oncology, 2006
- Different anthracycline derivates for reducing cardiotoxicity in cancer patientsPublished by Wiley ,2004
- Randomized study comparing 4′‐epi‐doxorubicin (Epirubicin) versus doxorubicin as a part of induction treatment in adult acute lymphoblastic leukemiaAmerican Journal of Hematology, 2002
- Protective effect of Coenzyme Q10 on anthracyclines cardiotoxicity: Control study in children with acute lymphoblastic leukemia and non-Hodgkin lymphomaMolecular Aspects of Medicine, 1994
- Results of Medical Research Council Childhood Leukaemia Trial UKALL VIII (Report to the Medical Research Council on behalf of the Working Party on Leukaemia in Childhood)British Journal of Haematology, 1991
- Clinical and cytokinetic aspects of remission induction of childhood acute lymphoblastic leukemia (ALL): Addition of an anthracycline to vincristine and prednisoneMedical and Pediatric Oncology, 1977