4 CASES OF ACUTE CARDIAC DYSFUNCTION INDUCED BY HIGH-DOSE CYTARABINE CHEMOTHERAPY

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Abstract

Background

Cytarabine (Ara-C) is the key drug of AML therapy. It is used not only in remission induction therapy but in consolidation therapy. Moreover, in CBF leukemia patient, consolidation therapy with high dose Ara-C alone therapy (HD-AC) achieves better prognosis than with conventional standard-dose multiagent chemotherapy. Severe myelo-suppression, infection and keratitis are major adverse events with HD-AC, but cardiac toxicity or dysfunction is reported rare. We experienced 4 cases of reversible cardiac dysfunction induced by HD-AC. Methods: We collected medical information from patients who received HD-AC at our hospital from April 2002 to August 2010. We also compared with patients who received conventional consolidation therapy between July 1998 and July 2011.

Results

Their mean age is 45.8 (28–58), 3 of them are female. Three patients are CBF leukemia (two are t(8;21), one is inv.16). All of them achieved complete remission by remission induction therapy. They received HD-AC as consolidation therapy. Mean of ejection fraction was decreased from 67.7 to 47.3%. 3 patients were recovered with in 2 week. Only one patient, it was required for 6 months to recover.

Conclusions

In our hospital, 10 patients received HD-AC as first consolidation therapy. In 4 heart failure patients, 3 were suffered from sepsis. On the other hand, 10 patients received conventional consolidation therapy. 3 patients suffered from sepsis (eight events), but there were no findings of heart failure. Therefore, we consider that in the patients received HD-AC therapy, heart failure appears severely initiated by infection. Several pericarditis or arrhythmia caused by HD-AC had already reported, although almost all reports were single case report. In conclusion, our report highlighted a high incidence of heart failure in patients who received HD-AC, and cardiac function should be carefully monitored in such cases.

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