Pregnancy and Cardiomyopathy After Anthracyclines in Childhood

Kara Annette Thompson, Kara Annette Thompson

Abstract

With advances in cancer therapy, there has been a remarkable increase in survival in children diagnosed with malignancies. Many of these children are treated with anthracyclines which are well known to cause cardiotoxicity. As more childhood cancer survivors reach childbearing age, many will choose to become pregnant. At this time, the factors associated with development of cardiomyopathy after anthracycline treatment are not clearly identified. It is possible that cardiac stress could predispose to cardiac deterioration in a patient with reduced functional reserve from prior anthracycline exposure. Pregnancy is one form of cardiovascular stress. The cardiac outcomes of pregnancy in childhood cancer survivors must be considered. In view of limited data, guidelines for pregnancy planning, management, and monitoring after cardiotoxic cancer therapy have not been established. This review summarizes the limited data available on the topic of pregnancy after anthracyclines in childhood.

Keywords: anthracyclines; cardiotoxicity; childhood; pregnancy; survivor.

Figures

Figure 1
Figure 1
Proposed Monitoring Algorithm.

References

    1. Lipshultz SE, Adams MJ, Colan SD, Constine LS, Herman EH, Hsu DT, et al. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation (2013) 128(17):1927–95. 10.1161/CIR.0b013e3182a88099
    1. Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, et al. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the international late effects of childhood cancer guideline harmonization group. Lancet Oncol (2015) 16(3):e123–36. 10.1016/S1470-2045(14)70409-7
    1. Shan K, Lincoff AM, Young JB. Anthracycline-induced cardiotoxicity. Ann Intern Med (1996) 125(1):47–58. 10.7326/0003-4819-125-1-199607010-00008
    1. Zhang S, Liu X, Bawa-Khalfe T, Lu LS, Lyu YL, Liu LF, et al. Identification of the molecular basis of doxorubicin-induced cardiotoxicity. Nat Med (2012) 18(11):1639–42. 10.1038/nm.2919
    1. Vejpongsa P, Yeh ET. Prevention of anthracycline-induced cardiotoxicity: challenges and opportunities. J Am Coll Cardiol (2014) 64(9):938–45. 10.1016/j.jacc.2014.06.1167
    1. Lipshultz SE, Alvarez JA, Scully RE. Anthracycline associated cardiotoxicity in survivors of childhood cancer. Heart (2008) 94(4):525–33. 10.1136/hrt.2007.136093
    1. Lipshultz SE, Colan SD, Gelber RD, Perez-Atayde AR, Sallan SE, Sanders SP. Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med (1991) 324(12):808–15. 10.1056/NEJM199103213241205
    1. Ali MK, Ewer MS, Gibbs HR, Swafford J, Graff KL. Late doxorubicin-associated cardiotoxicity in children. The possible role of intercurrent viral infection. Cancer (1994) 74(1):182–8.
    1. Davis LE, Brown CE. Peripartum heart failure in a patient treated previously with doxorubicin. Obstet Gynecol (1988) 71(3 Pt 2):506–8.
    1. Goorin AM, Chauvenet AR, Perez-Atayde AR, Cruz J, Mckone R, Lipshultz SE. Initial congestive heart failure, six to ten years after doxorubicin chemotherapy for childhood cancer. J Pediatr (1990) 116(1):144–7. 10.1016/S0022-3476(05)81668-3
    1. Lipshultz SE, Lipsitz SR, Mone SM, Goorin AM, Sallan SE, Sanders SP, et al. Female sex and higher drug dose as risk factors for late cardiotoxic effects of doxorubicin therapy for childhood cancer. N Engl J Med (1995) 332(26):1738–44. 10.1056/NEJM199506293322602
    1. Katz A, Goldenberg I, Maoz C, Thaler M, Grossman E, Rosenthal T. Peripartum cardiomyopathy occurring in a patient previously treated with doxorubicin. Am J Med Sci (1997) 314(6):399–400.
    1. Pan PH, Moore CH. Doxorubicin-induced cardiomyopathy during pregnancy: three case reports of anesthetic management for cesarean and vaginal delivery in two kyphoscoliotic patients. Anesthesiology (2002) 97(2):513–5. 10.1097/00000542-200208000-00034
    1. Hines MR, Mulrooney DA, Hudson MM, Ness KK, Green DM, Howard SC, et al. Pregnancy-associated cardiomyopathy in survivors of childhood cancer. J Cancer Surviv (2016) 10(1):113–21. 10.1007/s11764-015-0457-8
    1. Thompson KA, Hildebrandt MA, Ater JL. Cardiac outcomes with pregnancy after cardiotoxic therapy for childhood cancer. J Am Coll Cardiol (2017) 69(5):594–5. 10.1016/j.jacc.2016.11.040
    1. van Dalen EC, van der Pal HJ, van den Bos C, Kok WE, Caron HN, Kremer LC. Clinical heart failure during pregnancy and delivery in a cohort of female childhood cancer survivors treated with anthracyclines. Eur. J. Cancer (2006) 42(15):2549–53. 10.1016/j.ejca.2006.04.014
    1. Bar J, Davidi O, Goshen Y, Hod M, Yaniv I, Hirsch R. Pregnancy outcome in women treated with doxorubicin for childhood cancer. Am J Obstet Gynecol (2003) 189(3):853–7. 10.1067/S0002-9378(03)00837-8
    1. Bar J, Davidi O, Goshen Y, Hod M, Yaniv I, Hirsch R. Pregnancy outcome in women treated with doxorubicin for childhood cancer. Am J Obstet Gynecol (2003) 189(3):853–7. 10.1067/S0002-9378(03)00837-8
    1. Chow EJ, Chen Y, Kremer LC, Breslow NE, Hudson MM, Armstrong GT, et al. Individual prediction of heart failure among childhood cancer survivors. J Clin Oncol (2015) 33(5):394–402. 10.1200/JCO.2014.56.1373
    1. Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation (1978) 58(3 Pt 1):434–41. 10.1161/01.CIR.58.3.434
    1. Warnes CA.Pregnancy and heart disease Mann D, Zipes D, Libby P, Bonow R, Braunwald's Heart Disease. 10 ed Philadelphia: Elsevier; (2015).
    1. Elkayam U. Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy. J Am Coll Cardiol (2014) 64(15):1629–36. 10.1016/j.jacc.2014.07.961
    1. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation (2001) 104(5):515–21. 10.1161/hc3001.093437
    1. Stergiopoulos K, Shiang E, Bench T. Pregnancy in patients with pre-existing cardiomyopathies. J Am Coll Cardiol (2011) 58(4):337–50. 10.1016/j.jacc.2011.04.014
    1. Shankar SM, Marina N, Hudson MM, Hodgson DC, Adams MJ, Landier W, et al. Monitoring for cardiovascular disease in survivors of childhood cancer: report from the cardiovascular disease task force of the children's oncology group. Pediatrics (2008) 121(2):e387–96. 10.1542/peds.2007-0575
    1. Sieswerda E, Postma A, van Dalen EC, van der Pal HJ, Tissing WJ, Rammeloo LA, et al. The dutch childhood oncology group guideline for follow-up of asymptomatic cardiac dysfunction in childhood cancer survivors. Ann Oncol (2012) 23(8):2191–8. 10.1093/annonc/mdr595

Source: PubMed

3
Subscribe