Abstract 20432: Diagnostic Value of Cardiac Troponin T, N-Terminal Pro-Brain Natriuretic Peptide, and High-Sensitivity C-Reactive Protein During Doxorubicin Therapy in Children with Acute Lymphoblastic Leukemia
Introduction: Doxorubicin causes cardiac injury in children with acute lymphoblastic leukemia. Measuring biomarkers during therapy might help individualize treatment by immediately identifying cardiac injury.
Hypothesis: We assessed the hypothesis that serum levels of cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) measured during therapy would correlate with cardiac parameters assessed by echocardiography following treatment.
Methods: Children with high-risk acute lymphoblastic leukemia were randomly assigned to receive doxorubicin alone (n=74) or doxorubicin with dexrazoxane (n=80). Before, during, and after treatment, we obtained echocardiograms and serial measurements of cTnT, NT-proBNP, and hsCRP.
Results: cTnT was elevated (>0.01 ng/mL) in 12% of the doxorubicin group and in 13% of the doxorubicin-dexrazoxane group at baseline, but in 47% of the doxorubicin group and 13% of the doxorubicin-dexrazoxane group after treatment (P=0.005). NT-pro-BNP was elevated in 89% of the doxorubicin group and in 92% of the doxorubicin-dexrazoxane group at baseline, but in 48% of the doxorubicin group and 20% of the doxorubicin-dexrazoxane group after treatment (P=0.07). The percentage of children with elevated hsCRP levels did not differ between groups before, during or after treatment. Elevations in cTnT detected in the first 90 days of treatment were associated with abnormally reduced left ventricular mass and left ventricular end-diastolic posterior wall thickness 4 years later (P<0.01), and elevations in NT-proBNP during treatment were related to an abnormal left ventricular thickness-to-dimension ratio, suggesting ventricular remodeling, 4 years later (P=0.01). Elevations in hsCRP were not associated with any echocardiographic variable 4 years later.
Conclusions: Monitoring cTnT and NT-proBNP levels in children with acute lymphoblastic leukemia during treatment with doxorubicin may help identify those at risk for developing echocardiographic-evident cardiac injury up to 4 years later.
- © 2010 by American Heart Association, Inc.