Dexrazoxane Associated With Preserved Cardiac Function After Childhood Cancer Treatment

A Children's Oncology Group ALTE11C2 analysis examined longitudinal cardiac function in 895 patients treated with doxorubicin across five childhood cancer protocols. Four protocols included upfront randomized assignment to dexrazoxane or no dexrazoxane. Investigators analyzed 2,279 echocardiograms, including 1,581 centrally remeasured studies, adjusting for demographic and treatment factors and echocardiogram data type. Mean follow-up was 5.9 years; 230 patients had at least 10 years of follow-up. Median doxorubicin exposure was 360 mg/m², and 51% received dexrazoxane.

Dexrazoxane exposure was associated with better preserved left ventricular systolic function, with a z-score difference of 0.4 (95% CI, 0.2–0.5). Adjusted hazard ratios for reduced function occurring after one and five years postdiagnosis were 0.58 (95% CI, 0.41–0.82) and 0.54 (95% CI, 0.31–0.93), respectively. Reduced function was defined as fractional shortening below 30% or ejection fraction below 50%. Among patients classified as high risk under current cardiomyopathy screening guidelines, event rates were 21.8 with dexrazoxane versus 40 per 1,000 person-years without it (P=.001).

The findings support long-term cardioprotection associated with dexrazoxane and suggest potential implications for surveillance intensity. However, the endpoints were echocardiographic rather than clinical heart failure, one protocol lacked random assignment, and some measurements came from institutional reports. The abstract does not establish a revised screening schedule; full text was unavailable for review.