Introduction: The mainstay of management of most paediatric
malignancies is chemotherapy which has significantly increased the survival of
most children with malignancies from 20–30% in the 1960s when chemotherapy was
introduced, to 83% in 2014. However, the use of some of these chemotherapeutic
agents such as anthracyclines is limited by their toxicity profiles, especially
cardiac toxicity. Use of doxorubicin, an anthracycline chemotherapeutic agent
has been associated with late-occurring cardiac toxicities. Detection of early
occurring cardiac effects of cancer chemotherapy is essential to prevent the
occurrence of adverse events including toxicity, myocardial dysfunction, and
death.
Objective: The objective of the study is to investigate the
prevalence of elevated cardiac troponin T (cTnT) and associated factors of
myocardial injury in children on doxorubicin cancer chemotherapy.
Methods: A cross-sectional study design was adopted. It is a
hospital-based study conducted on children aged 1 month to 12.4 years who had a
diagnosis of cancer and were admitted at Kenyatta National Hospital (KNH).
Interventions and Outcomes: The patients underwent
Echocardiography (ECHO) before their scheduled chemotherapy infusion.
Twenty-four (24) hours after the chemotherapy infusion the patients had an
evaluation of the serum cardiac troponin T (cTnT) and a repeat ECHO. Myocardial
injury was defined as a cTnT level > 0.014 ng/ml or a Fractional Shortening
(FS) of < 29% on ECHO.
Data Analysis: Data collected were entered into a patient data
sheet and then transcribed to a computer database, SPSS version 23.0.
Descriptive, univariate, and multivariate analyses were done to determine the
factors associated with elevated cTnT.
Results: One hundred (100) children were included in the final
analysis. Thirty-two percent (32%) of the study population had an elevated
cTnT. A cumulative doxorubicin dose of > 175 mg/m2 was significantly
associated with an elevated cTnT (OR, 10.76; 95% CI, 1.18–97.92; p = 0.035).
Diagnosis of nephroblastoma was also associated with an elevated cTnT (OR, 3.0;
95% CI, 1.23–7.26) but not statistically significant (p = 0.105). Nine percent
(9%) of the participants had echocardiographic evidence of myocardial injury.
In evaluating anthracycline-induced cardiac injury for paediatric cancer
patients, troponins are reliable biomarkers since repeated anthracycline
chemotherapy exposure leads to detectable troponin levels in the peripheral
circulation. This is consistent with findings from our study whereby 77% of
patients were exposed to anthracyclines with 32% having elevated levels of cTnT
in a median treatment duration of 3 months.
Conclusion: When compared to echocardiography, elevated levels of
cTnT showed a higher association with early occurring chemotherapy-induced
myocardial injury among children on cancer treatment at a tertiary teaching and
referral hospital in Kenya. The study recommends that future research in this
field should explore the utility of cTnT as a screening test for the detection
of early-occurring myocardial injury among cancer patients commencing
chemotherapy and follow-up patients for a longer duration of time.
Author
(s) Details
Nyambura Kariuki
Department of Paediatrics and Child Health, School of Medicine, College of
Health Sciences, University of Nairobi, KNH, P. O. Box, Nairobi 19676-00202,
Kenya.
Esther Kimani
Department of Paediatrics and Child Health, School of Medicine, College of
Health Sciences, University of
Nairobi, KNH, P. O. Box, Nairobi 19676-00202, Kenya.
Christine Jowi
Department of Paediatrics and Child Health, School of Medicine, College of
Health Sciences, University of Nairobi, KNH, P. O. Box, Nairobi 19676-00202,
Kenya.
Dalton Wamalwa
Department of Paediatrics and Child Health, School of Medicine, College of Health
Sciences, University of Nairobi, KNH, P. O. Box, Nairobi 19676-00202, Kenya.
Jacky Y. Suen
Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road,
Chermside 4032, Queensland, Australia and Institute for Molecular Bioscience,
The University of Queensland, 306 Carmody Road, St Lucia 4067, Queensland,
Australia.
John F. Fraser
Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road,
Chermside 4032, Queensland, Australia and Institute for Molecular Bioscience,
The University of Queensland, 306 Carmody Road, St Lucia 4067, Queensland,
Australia.
Nchafatso G. Obonyo
Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road,
Chermside 4032, Queensland, Australia, Institute for Molecular Bioscience, The
University of Queensland, 306 Carmody Road, St Lucia 4067, Queensland,
Australia, Initiative to Develop African Research Leaders
(IDeAL)/KEMRI-Wellcome Trust Research Programme, P. O. Box 230-80108, Kilifi,
Kenya and Kenya Medical Association,
Nairobi, Kenya.
Please see the book here:- https://doi.org/10.9734/bpi/msti/v6/2838
