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        Cardiotoxicity of Mitoxantrone Treatment in a German Cohort of 639 Multiple Sclerosis Patients

        Vinzenz Fleischer,Anke Salmen,Susanne Kollar,Veronika Weyer,Volker Siffrin,Andrew Chan,Frauke Zipp,Felix Luessi 대한신경과학회 2014 Journal of Clinical Neurology Vol.10 No.4

        Background and Purpose The aim of this study was to elucidate the role of therapy-relatedcardiotoxicity in multiple sclerosis (MS) patients treated with mitoxantrone and to identify potential predictors for individual risk assessment. Methods Within a multicenter retrospective cohort design, cardiac side effects attributed tomitoxantrone were analyzed in 639 MS patients at 2 MS centers in Germany. Demographic,disease, treatment, and follow-up data were collected from hospital records. Patients regularlyreceived cardiac monitoring during the treatment phase. Results None of the patients developed symptomatic congestive heart failure. However, thefrequency of patients experiencing cardiac dysfunction of milder forms after mitoxantronetherapy was 4.1% (26 patients) among all patients. Analyses of the risk for cardiotoxicity revealed that cumulative dose exposure was the only statistically relevant risk factor associatedwith cardiac dysfunction. Conclusions The number of patients developing subclinical cardiac dysfunction below themaximum recommended cumulative dose is higher than was initially assumed. Interestingly, asubgroup of patients was identified who experienced cardiac dysfunction shortly after initiationof mitoxantrone and who received a low cumulative dose. Therefore, each administration ofmitoxantrone should include monitoring of cardiac function to enhance the treatment safety forpatients and to allow for early detection of any side effects, especially in potential high-risksubgroups (as determined genetically).

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