The N-terminal pro-brain natriuretic peptide as a marker of mitoxantrone-induced cardiotoxicity in multiple sclerosis patients

• Published in: Neurologia i neurochirurgia polska 2014-01, Vol.48 (2), p.111-115
• Main Authors: Podlecka-Piętowska, Aleksandra, Kochanowski, Janusz, Zakrzewska-Pniewska, Beata, Opolski, Grzegorz, Kwieciński, Hubert, Kamińska, Anna Maria
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Agents - toxicity; Biomarkers - blood; Cardiomyopathies - blood; Cardiomyopathies - chemically induced; Cardiomyopathies - diagnosis; Cardiotoxicity; Female; Heart Diseases - blood; Heart Diseases - chemically induced; Heart Diseases - diagnosis; Heart Failure - blood; Heart Failure - chemically induced; Heart Failure - diagnosis; Humans; Male; Middle Aged; Mitoxantrone; Mitoxantrone - administration & dosage; Mitoxantrone - adverse effects; Mitoxantrone - toxicity; Multiple sclerosis; Multiple Sclerosis - drug therapy; N-terminal pro-brain natriuretic peptide; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Peptides; Plasma; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - chemically induced; Ventricular Dysfunction, Left - diagnosis
• ISSN: 0028-3843; 1897-4260
• DOI: 10.1016/j.pjnns.2013.12.005

Mitoxantrone (MTX) has been shown to reduce progression of disability and number of clinical exacerbations in patients with progressive multiple sclerosis (MS). Prolonged administration of MTX, however, is limited by the risk of cardiotoxicity. Cardiac monitoring in MTX-treated patients includes usually measurement of left ventricular ejection fraction (LVEF) by means of echocardiography. The N-terminal pro-brain natriuretic peptide (NT-proBNP) represents a novel diagnostic tool in the assessment of heart failure. This study was aimed to evaluate the usefulness of NT-proBNP for early detection of MTX-induced cardiotoxicity in MS patients. We measured the NT-proBNP plasma levels in 45 MS patients who completed 24-month MTX therapy and in 37 MS patients of control group. The median NT-proBNP plasma value was 15.12pg/mL. In 12 MTX-treated patients (27%), NT-proBNP plasma values were elevated, though this subgroup of patients neither clinical showed evidence of myocardial damage nor had the LVEF value 10%. We did not observe correlations between the NT-proBNP levels and patient age, MS duration, relapses index, Extended Disability Status Scale (EDSS), MTX single dose and the total cumulative dose of MTX. In 8 patients (22%) from control group, NT-proBNP plasma levels were also elevated. The results of our study confirm that MTX therapy is safe for carefully selected and closely monitored MS patients. We believe that serial evaluation of NT-proBNP levels (before, during and after MTX therapy) can identify MS patients at high risk for MTX-induced cardiotoxicity.