Noninvasive early detection of anthracycline-induced cardiotoxicity in patients with hematologic malignancies using the phased tracking method.

Anthracyclines are among the most effective and widely used anticancer drugs; however, their use is limited by serious cardiotoxicity. Early detection is necessary to prevent the high mortality rate associated with heart failure (HF). We evaluated cardiac function in 142 patients using conventional echocardiography and the phased tracking method (PTM), which was measured using the minute vibration and the rapid motion components, neither of which is recognized in standard M-mode nor in tissue Doppler imaging. For systolic function comparison, we compared left ventricular ejection fraction (LVEF) in conventional echocardiography with the average velocity of ventricular septum myocytes (Vave ) in the PTM. The Vave of 12 healthy volunteers was 1.5 (m/s)/m or more. At baseline of 99 patients, there was a positive correlation between LVEF and Vave in all patients. There were no significant differences in baseline cardiac function between patients with and without HF. There was a negative correlation between the cumulative anthracycline dose and LVEF or Vave among all patients. We determined that Vave 1.5 (m/s)/m was equivalent to LVEF 60%, 1.25 (m/s)/m to 55%, and 1.0 (m/s)/m to 50%. During the follow-up period, there was a pathological decrease in LVEF (<55%) and Vave (<1.25 m/s/m) in patients with HF; decreases in Vave were detected significantly earlier than those in LVEF (P < 0.001). When Vave declined to 1.5 (m/s)/m or less, careful continuous observation and cardiac examination was required. When Vave further declined to 1.0 (m/s)/m or lower, chemotherapy was postponed or discontinued; thus, serious drug-induced cardiomyopathy was avoided in patients who did not relapse. The PTM was superior to echocardiography for early, noninvasive detection and intermediate-term monitoring of left ventricle systolic function associated with anthracycline chemotherapy, among patients with hematologic malignancies. The PTM was an effective laboratory procedure to avoid the progression to serious cardiomyopathy.

[A long-term survivor after relapsed acute myeloblastic leukemia with anthracycline dilated cardiomyopathy].

We watched and analyzed patient cardiac functions especially with a "Phased tracking method" to detect rapid motion of the heart. The patient suffered from congestive heart failure while depending on anthracycline cumulative doses, but now has been living more than 10 years after relapsed acute myeloblastic leukemia. To avoid congestive heart failure with increasing highly tumoricidal anthracycline doses, cardiac function should be monitored closely in connection with treatment schedules and proposed accurate therapeutic index.

[Cure of adult acute myeloblastic leukemia].

Despite major recent advances in the understanding of the molecular biology of adult acute myeloblastic leukemia(AML), the treatment of the disease remains challenging. This review summarizes literature in the field of curative chemotherapy for adult acute myeloblastic leukemia(AML). In particular, detailed analysis of curing leukemia in patients treated with risk-oriented chemotherapy and in patients with APL was presented. In addition, results using our curative chemotherapy approach for adult AML were reported. Lastly, future directions for curing adult AML were discussed.