Dexrazoxane can reduce the risk of cardiotoxicity from continued doxorubicin therapy but some patients may develop this complication. Doxorubicin plus dexrazoxane therapy should be discontinued if there is evidence of left ventricular dysfunction.
Criteria for left ventricular dysfunction:
(1) signs of congestive heart failure (CHF)
(2) reduction in left ventricular ejection fraction from baseline relative to the lower limit of normal for the institution (see table below)
Congestive heart failure is defined as 2 or more of the following:
(1) cardiomegaly on imaging studies
(2) S3 gallop
(3) basilar rales on lung auscultation
(4) significant dyspnea on exertion, orthopnea and/or paroxysmal nocturnal dyspnea
Decrease in LVEF from Baseline
LVEF as Percent of Baseline
Value Relative to Lower Limit of Normal (LLN)
>= 20%
<= 80%
NA
NA
NA
>= 5% decrease below
>=10%
<= 90%
less than LLN
decrease from baseline =
= ((baseline in percent) - (current in percent)) / (baseline in percent) * 100%
decrease from LLN =
= ((LLN in percent) - (current in percent)) / (LLN in percent) * 100%
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