Abstract

Background: Antracyclines (ANTR) are powerful antineoplastic agents and play an important role in treatment of acute lymphoblastic leukaemia (ALL). However, a potential heart damage caused by ANTR in patients who have been cured of cancer may lessen the success of their cure. Dexrazoxane (ICRF-187), a chelator of intracellular iron, has been shown to offer protection against the cardiomyopathic properties of antracyclines. Atrial natriuretic peptide (ANP) levels, especially receptors for proANP (1–98) and plasma brain natriuretic peptide (BNP) levels are markedly increased in cardiac impairment.

Objectives of the study: We aimed to measure the immunoreactive proANP (1–98) and N-terminal proBNP (8–29) (Nt-proBNP) in children with ALL after completion of treatment with ANTR under the protective cover of ICRF-187.

Methods used: Concentration of plasma N-terminal part proANP and NT-proBNP was measured in children by enzyme immunoassay (Biomedica). Median age at diagnosis was 5.5 years.

Results: Mean proANP plasma levels were within the normal range both in girls (1061.2 fmol/ml) and boys (778 fmol/ml). However there was a statistically significant difference between the levels in girls and boys. Mean Nt-proBNP plasma levels were normal - 273.3 fmol/ml in all examined children. Out of the 81 patients 5 (6.2%) had slightly elevated Nt-proBNP levels in comparison with healthy subjects. Nt-proBNP plasma levels were not significantly different in boys (261.0 fmol/ml) in comparison with girls (285.4 fmol/ml).

Conclusion: Our preliminary results suggest that measurement of proANP and Nt-proBNP plasma levels is useful in the detection of subclinical left ventricular dysfunction in children receiving antracycline therapy. Cardioprotection with Dexrazoxane in ALL patients treated with 240mg/m² of ANTR was justified and effective. Further, long term follow-up of the studied patients would be necessary to determine the clinical significance of Nt-proBNP increase.

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*KBN grant 3 PO5E 123 23