1. ¹Divisione Oncologia Medica, Ospedale San Bortolo, Vicenza, Italy
2. ²Divisione Cardiologia, Ospedale San Bortolo, Vicenza, Italy
3. ³Divisione Ematologia, Ospedale San Bortolo, Vicenza, Italy
4. ⁴Divisione Oncologia Medica Falck, Ospedale Niguarda Ca' Granda, Milano, Italy

Correspondence: Dr P Morandi, Medical Oncology, S Bortolo General Hospital, Viale Rodolfi 37, Vicenza, Italy. E-mail: paolomorandi1@tin.it

⁵These authors contributed equally to this work

Received 3 March 2004; Accepted 4 October 2004; Published online 15 November 2004.

Abstract

Cardiac toxicity is an uncommon but potentially serious complication of high-dose (HD) chemotherapy and little is known about incidence, severity and underlying mechanisms. We have systematically reviewed the literature of the last 30 years to summarize and appraise the published evidence on cardiac toxicity associated with HD chemotherapy. HD cyclophosphamide-containing regimens have been most commonly associated with cardiac toxicity, with a progressively decreasing incidence over time. Dosage, application regimens and coadministration of other chemotherapeutic agents emerged as risk factors. While cardiac toxicity has been rarely associated with other cytotoxic drugs, an unexpected incidence of severe cardiotoxicity resulted from reduced-intensity conditioning regimens containing melphalan and fludarabine. Predictive value of cardiologic examination of patients is limited, and patients with a slight depression of cardiac performance could tolerate HD chemotherapy. Clinical examination, resting electrocardiography and dosage adjustment in overweight patients remain the mainstay of prevention, with bidimensional echocardiography (2D echo) for patients with a history of anthracycline exposure. Strategies to decrease the long-term negative impact of anthracycline administration on cardiac performance are being investigated. New 2D echo-based techniques and circulating markers of cardiac function hold promise for allowing identification of patients at high risk for and early diagnosis of cardiac toxicity.