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Chemotherapy for cancer causes number of British children to need heart transplants.

More than a dozen British children have required heart transplants as a result of cancer chemotherapy given years earlier, and doctors warn that as more youngsters survive what once were fatal malignancies, the number requiring such life-saving surgery may increase.

Anthracycline agents, used in treating a number of pediatric cancers including leukemia and sarcomas (cancer of the connective tissue) are known to be toxic to heart cells. In the short term, uninjured cardiac cells usually can compensate and keep the heart pumping normally. But if the damage is severe, heart function may deteriorate over time.

Ian Sullivan, MD, a consultant cardiologist at Great Ormond Street Children's Hospital in London, said that between 1970 and 1995, 13 young people whose heart function had been damaged by previous anthracycline chemotherapy had received heart transplants. Another child was put on the waiting list but died before surgery.

Sullivan, who will be discussing the effects of anthracycline therapy at a pediatric cancer conference in Edinburgh, Scotland later this month, said that doctors had thought that reducing anthracycline dosage would avoid this dangerous side effect, but this has not proven to be true. "Over the last decades, as young people have survived Longer after cancer, it has become apparent that children who had been effectively cured from their cancers were later having impairment of cardiac function," he said. "Previously, children died of cancer. Now we have a situation where more and more are being successfully treated, so attention has to shift not just from keeping them alive but also to minimizing deleterious effects."

Specialists plan on minimizing damage by further reducing anthracyline dosage as well as modifying the way these drugs are administered and, if possible, giving other medications simultaneously that might prevent cardiac injury. In the longer term, it is hoped that safer classes of drugs will be developed that will render the anthracycline group obsolete.

Putting a positive spin on the report, organizations devoted to curing pediatric cancers said that the new complications were a testament to the success of cancer treatment. Two decades ago less than half of all youngsters diagnosed with cancer survived. Today, thanks to medical advances and a better understanding of the disease process, the number has increased to 70%.

The idea of an organ transplant for a cancer patient would have been unthinkable 15 years ago, said Jenny Whelan, spokesperson for the group CancerBacup. "The expectation for children to survive cancer is far higher today."
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Publication:Transplant News
Date:Sep 30, 1998
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