Peculiarities of metabolic cardioprotection in children with anthracycline cardiomyopathy




acute leukemia, chemotherapy, doxorubicin, cardiomyopathy, children


Protocol chemotherapy of acute leukemia in children involves the use of cardiotoxic drugs, in particular anthracycline antibiotics. Pathomorphological lesions of the heart in such patients can form heart failure. Modern theories of the pathogenesis of anthracycline cardiomyopathy in children highlight only certain aspects of its development, which requires the study of pathogenetic links, early clinical diagnostic markers and their effective correction.

Aim - to establish early diagnostic criteria for heart damage in children with acute leukemia on the background of cardiotoxic therapy.

Materials and methods. 70 children with acute leukemia treated according to ALL IC BFM 2009 protocols were examined. They were examined at the pre-protocol stage, at the end of the first phase I and II protocols. According to the cumulative dose of doxorubicin, patients were divided into I and II groups. Each of the groups, in turn, was divided into subgroups (with cardioprotection and without cardioprotection). For the purpose of cardioprotection, an L-carnitine-containing preparation was used.

Results. It has been established that oxidative stress develops in patients with acute leukemia as a result of the use of anthracyclines, which is accompanied by the activation of antioxidant defenses. In addition, there are manifestations of energy deficiency with a predominance of anaerobic glycolysis. Manifestation of acute leukemia was an increase in natriuretic hormone. The influence of the cumulative dose of doxorubicin on the cardiovascular system in children with acute leukemia was analyzed, and metabolic cardioprotection with an L-carnitine-containing drug was also performed.

Conclusions. The formation of cardiotoxic lesions of the myocardium in the form of anthracycline cardiomyopathy in patients with acute leukemia receiving protocol chemotherapy leads to a 4.5-fold increase in the level of natriuretic hormone already at the end of the first phase I of the protocol. At the same time, the maximum values of the heart failure marker are characteristic of children who received a higher cumulative dose of anthracycline at the end of protocol chemotherapy. It has been established that cardioprotection with an L-carnitine-containing drug stabilizes the indicators of protein and lipid peroxidation by two times, reduces the manifestations of myocardial energy deficiency, and lowers the level of the heart failure marker.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

The authors declare no conflict of interest.


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