Anthracyclines are commonly used to treat childhood leukemias and lymphomas, as well as other malignancies, leading to a growing population of long-term childhood cancer survivors. However, their use is limited by cardiotoxicity, increasing survivors' vulnerability to treatment-related complications that can markedly affect their quality of life. Survivors are more likely to suffer from heart failure, coronary artery disease, and cerebrovascular accidents compared to the general population. The specific mechanisms of anthracycline cardiotoxicity are complex and remain unclear. Hence, determining the factors that may increase susceptibility to cardiotoxicity is of great importance, as is monitoring patients during and after treatment. Additionally, treatment and prevention options, such as limiting cumulative dosage, liposomal anthracyclines, and dexrazoxane, continue to be explored. Here, we review the cardiovascular complications associated with the use of anthracyclines in treating malignancies in children and discuss methods for preventing, screening, and treating such complications in childhood cancer survivors. 1. Introduction Cancer is diagnosed in more than 12,000 children in the United States every year [1]. Over the past 25 years, the 5- and 10-year survival rates for childhood cancers have substantially improved, from less than 50% in the 1970s to almost 80% today [2, 3]. Some of this improvement comes from the use of anthracycline chemotherapeutic agents, which are widely used to treat childhood leukemias and lymphomas, as well as other malignancies. Their use has helped create a growing population of long-term childhood cancer survivors of more than 325,000 in the United States alone [4]. However, this growing population of survivors is at a substantial risk for treatment-related complications that can markedly affect their quality of life. Increasingly, survivors and their clinicians are realizing the importance of continuous monitoring long after their cancer treatment has been completed. Within the first 30 years after diagnosis, 75% of childhood cancer survivors will suffer from a chronic health condition [5]. Recent 5-year estimates indicate that the leading non-cancer-related cause of morbidity and mortality in long-term survivors of childhood cancer is cardiovascular-related disease [5–10]. Survivors are 8 times more likely than the general population to die from cardiovascular-related disease, and compared to sibling controls, they are 15 times as likely to suffer from heart failure (HF), more than 10 times as likely to have coronary
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