Today we discussed the adult complications of childhood lymphoma therapies, particularly early onset heart disease. Great learning points were made, which include:
1. Coronary artery disease is the most common complication of mediastinal radiation therapy. Others include valvular disease, cardiomyopathy, conduction abnormalities, prolonged QTc, and pericarditis.
2. The mechanism of cardiotoxicity of doxorubicin is through an increase of oxidative stress, leading to subcellular changes and apoptosis, and ultimately a cardiomyopathy.
3. Cardioprotective strategies in doxorubicin-induced cardiotoxicity include Dexrazoxane, ACEi, beta blocker, and iron chelation. Dexrazoxane (mechanism: intracellular iron chelator, reduces oxidative radical production) is the only FDA approved drug for anthracycline-mediated cardiotoxicity, though is somewhat controversial whether or not it affects the anti-tumor activity of the anthracycline.