(ChemotherapyAdvisor) – The cardiac injury biomarker cardiac troponin (cTnT) and the cardiomyopathy biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) may hold promise as biomarkers of cardiotoxicity in children with high-risk acute lymphoblastic leukemia (ALL) during treatment with doxorubicin, according to a study published in the Journal of Clinical Oncology online February 27.
Children with high-risk ALL were randomly assigned to receive doxorubicin alone (n=100; 75 analyzed) or doxorubicin with dexrazoxane (n=105; 81 analyzed). Echocardiograms and serial serum measurements of cTnT, NT-proBNP, and the inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) were obtained before, during, and after treatment.
Prior to treatment, levels of cTnT were increased in 12% of children in the doxorubicin group and in 13% of the doxorubicin-dexrazoxane group and in 47% and 13%, respectively, after treatment. Levels of NT-proBNP were increased in 89% of children in the doxorubicin group and in 92% of children in the doxorubicin-dexrazoxane group before treatment but in only 48% and 20%, respectively, after treatment. Percentage of children with increased hsCRP levels did not differ between groups at any time point.
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Detectable increases in cTnT in the first 90 days of treatment were associated with abnormally reduced left ventricular (LV) mass and LV end-diastolic posterior wall thickness four years later. Increases in NT-proBNP were related to an abnormal LV thickness-to-dimension ratio, suggesting LV remodeling four years later. HsCRP increases were not associated with any echocardiographic variables.
The authors concluded that definitive validation studies are required to establish a range of clinical utility for these cardiac biomarkers.
