Permissive Cardiotoxicity and Determination of Anthracycline Risk With Previous Anthracycline Exposure.

Anthracyclines are an effective treatment for hematologic malignancies but have significant risk of cardiotoxicity that increases with lifetime dose, best characterized for doxorubicin. However, patients may receive different anthracycline formulations, and cardiotoxic dose equivalency for nondoxorubicin anthracyclines is uncertain, making it challenging to calculate a patient's lifetime dose to make decisions about safety of additional anthracycline treatment and risk stratification for monitoring and cardioprotective strategies. In addition, dexrazoxane reduces the risk of cardiovascular toxicity with anthracyclines but how to incorporate previous dexrazoxane treatment into risk stratification is unclear. Here, a young woman previously treated with anthracyclines as induction therapy for acute myeloid leukemia and concern for previous anthracycline cardiotoxicity presented with disease relapse. Because optimal therapy included retreatment with anthracyclines, this case demonstrates the multidisciplinary discussion for her case, reviewing the risks and benefits of repeat anthracycline exposure and detailing the evidence for strategies to monitor and prevent worsening cardiotoxicity.