RISK FACTORS AND INCIDENCE OF MYOCARDIAL DAMAGE IN PATIENTS WITH HEMOBLASTOSIS RECEIVING ANTHRACYCLIN ANTIBIOTICS

Introduction. The anthracycline antibiotics cause clinically significant manifestations of cardiotoxicity (СТ) – myocardial injuries, reducing both quality and life expectancy of the oncological patients.

The purpose of the study was to evaluate the incidence and risk factors anthracycline-induced СТ in patients with hemoblastosis.

Materials and methods. The study included 131 case histories of patients with hemoblastosis, treated with anthracyclines. Patients were divided into two groups according to age – the 1st group involved 77 patients aged from 18 up to 50 years (average age of 25.6 ± 3.4 years), the 2nd – 54 patients aged from 51 up to 75 years (average age of 56.8 ± 4.6 years). At the first investigation phase we studied the incidence of anthracycline-induced СТ in various age groups patients. The second phase devoted to studying potential risk factors (a cumulative dose more than 240 mg/m², a female, an age, the accompanying application of mediastinal radiation therapy or other cardiotoxic drugs, cardioprotection absence) influence on anthracycline-induced CD frequency.

Results. The incidence of CT in young patients was 38.2% (95% confidence interval (CI) 25.6–51.6%), among the older age group – 14.3% (95% CI 5.3–26.7%). The incidence of CT is significantly higher among young people (χ²  = 5.63, p = 0.018). According to the results of univariate regression analysis, significant risk factors for the development of myocardial damage in patients with CT signs were: age <50 years – the odds ratio (OR) 2.69; 95% CI 1.05–6.84; the cumulative anthracycline dose more than 240 mg/m²  by doxorubicin (OR 5.17, 95% CI 1.38–27.55)  and the absence of prophylactic cardioprotective therapy (OR 23.38, 95% CI 6.49–84.14 ). In multivariate regression analysis independent risk factors for myocardial damage development were only the cumulative anthracyclines dose more than 240 mg/m²  (OR 6.17, 95% CI 1.32–28.71)  and the absence of prophylactic cardioprotective therapy (OR 2.82, 95% CI 1.09–7.28).

Conclusions. Statistically significant higher anthracycline-induced cardiotoxicity frequency appeared in young patients. Reliable (р <0.05) cardiotoxicity risk factors were cumulative dose more than 240 mg/m²  and cardioprotection absence.