TY - JOUR
T1 - Primary cardioprotection with dexrazoxane in patients with childhood cancer who are expected to receive anthracyclines
T2 - recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group
AU - de Baat, Esmée C.
AU - van Dalen, Elvira C.
AU - Mulder, Renée L.
AU - Hudson, Melissa M.
AU - Ehrhardt, Matthew J.
AU - Engels, Frederike K.
AU - Feijen, Elizabeth A.M.
AU - Grotenhuis, Heynric B.
AU - Leerink, Jan M.
AU - Kapusta, Livia
AU - Kaspers, Gertjan J.L.
AU - Merkx, Remy
AU - Mertens, Luc
AU - Skinner, Roderick
AU - Tissing, Wim J.E.
AU - de Vathaire, Florent
AU - Nathan, Paul C.
AU - Kremer, Leontien C.M.
AU - Mavinkurve-Groothuis, Annelies M.C.
AU - Armenian, Saro
N1 - Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/12
Y1 - 2022/12
N2 - Survivors of childhood cancer are at risk of anthracycline-induced cardiotoxicity, which might be prevented by dexrazoxane. However, concerns exist about the safety of dexrazoxane, and little guidance is available on its use in children. To facilitate global consensus, a working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the existing literature and used evidence-based methodology to develop a guideline for dexrazoxane administration in children with cancer who are expected to receive anthracyclines. Recommendations were made in consideration of evidence supporting the balance of potential benefits and harms, and clinical judgement by the expert panel. Given the dose-dependent risk of anthracycline-induced cardiotoxicity, we concluded that the benefits of dexrazoxane probably outweigh the risk of subsequent neoplasms when the cumulative doxorubicin or equivalent dose is at least 250 mg/m2 (moderate recommendation). No recommendation could be formulated for cumulative doxorubicin or equivalent doses of lower than 250 mg/m2, due to insufficient evidence to determine whether the risk of cardiotoxicity outweighs the possible risk of subsequent neoplasms. Further research is encouraged to determine the long-term efficacy and safety of dexrazoxane in children with cancer.
AB - Survivors of childhood cancer are at risk of anthracycline-induced cardiotoxicity, which might be prevented by dexrazoxane. However, concerns exist about the safety of dexrazoxane, and little guidance is available on its use in children. To facilitate global consensus, a working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the existing literature and used evidence-based methodology to develop a guideline for dexrazoxane administration in children with cancer who are expected to receive anthracyclines. Recommendations were made in consideration of evidence supporting the balance of potential benefits and harms, and clinical judgement by the expert panel. Given the dose-dependent risk of anthracycline-induced cardiotoxicity, we concluded that the benefits of dexrazoxane probably outweigh the risk of subsequent neoplasms when the cumulative doxorubicin or equivalent dose is at least 250 mg/m2 (moderate recommendation). No recommendation could be formulated for cumulative doxorubicin or equivalent doses of lower than 250 mg/m2, due to insufficient evidence to determine whether the risk of cardiotoxicity outweighs the possible risk of subsequent neoplasms. Further research is encouraged to determine the long-term efficacy and safety of dexrazoxane in children with cancer.
UR - http://www.scopus.com/inward/record.url?scp=85139009680&partnerID=8YFLogxK
U2 - 10.1016/S2352-4642(22)00239-5
DO - 10.1016/S2352-4642(22)00239-5
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C2 - 36174614
AN - SCOPUS:85139009680
SN - 2352-4642
VL - 6
SP - 885
EP - 894
JO - The Lancet Child and Adolescent Health
JF - The Lancet Child and Adolescent Health
IS - 12
ER -