IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer

Theodorus W. Kouwenberg; Elvira C. van Dalen; Renée L. Mulder; Saro Armenian; Elizabeth A.M. Feijen; Eric J. Chow; Helen Kosmidis; Britta J. Vormoor-Bürger; Chikako Kiyotani; Paul C. Nathan; Livia Kapusta; Heynric B. Grotenhuis; Frederike K. Engels; Arco J. Teske; Athanasios Tragiannidis; Martijn G. Slieker; Shuichi Ozono; Anju Nohria; Tomáš Sláma; Roderick Skinner; Melissa M. Hudson; Leontien C.M. Kremer; Matthew J. Ehrhardt; Annelies M.C. Mavinkurve-Groothuis

doi:10.1016/j.jaccao.2025.05.009

IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer

Theodorus W. Kouwenberg
, Elvira C. van Dalen
, Renée L. Mulder
, Saro Armenian
, Elizabeth A.M. Feijen
, Eric J. Chow
, Helen Kosmidis
, Britta J. Vormoor-Bürger
, Chikako Kiyotani
, Paul C. Nathan
, Livia Kapusta
, Heynric B. Grotenhuis
, Frederike K. Engels
, Arco J. Teske
, Athanasios Tragiannidis
, Martijn G. Slieker
, Shuichi Ozono
, Anju Nohria
, Tomáš Sláma
, Roderick Skinner

Melissa M. Hudson, Leontien C.M. Kremer, Matthew J. Ehrhardt, Annelies M.C. Mavinkurve-Groothuis

Group Kremer

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Anthracycline and anthraquinone agents are major contributors to cancer therapy–related cardiac dysfunction in childhood cancer. However, evidence-based equivalence ratios for estimating individual risk have not been incorporated into international surveillance guidelines. The International Late Effects of Childhood Cancer Guideline Harmonization Group systematically reviewed the literature on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Based on available evidence, benefit–harm considerations, and expert consensus, the panel concluded that the risk of cardiac dysfunction is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin (moderate-quality evidence; strong recommendation). The panel recommends using an approximate ratio of 0.6 to convert daunorubicin to a doxorubicin-equivalent dose and a ratio of 10.5 for mitoxantrone (low-quality evidence; moderate recommendation). No recommendation was made for epirubicin or idarubicin due to inconclusive evidence.

Original language	English
Pages (from-to)	683-690
Number of pages	8
Journal	JACC: CardioOncology
Volume	7
Issue number	6
DOIs	https://doi.org/10.1016/j.jaccao.2025.05.009
Publication status	Published - Oct 2025

Access to Document

10.1016/j.jaccao.2025.05.009

Cite this

Kouwenberg, T. W., van Dalen, E. C., Mulder, R. L., Armenian, S., Feijen, E. A. M., Chow, E. J., Kosmidis, H., Vormoor-Bürger, B. J., Kiyotani, C., Nathan, P. C., Kapusta, L., Grotenhuis, H. B., Engels, F. K., Teske, A. J., Tragiannidis, A., Slieker, M. G., Ozono, S., Nohria, A., Sláma, T., ... Mavinkurve-Groothuis, A. M. C. (2025). IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer. JACC: CardioOncology, 7(6), 683-690. https://doi.org/10.1016/j.jaccao.2025.05.009

@article{3ac1c832dcef4523903c2657eddde5bb,

title = "IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer",

abstract = "Anthracycline and anthraquinone agents are major contributors to cancer therapy–related cardiac dysfunction in childhood cancer. However, evidence-based equivalence ratios for estimating individual risk have not been incorporated into international surveillance guidelines. The International Late Effects of Childhood Cancer Guideline Harmonization Group systematically reviewed the literature on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Based on available evidence, benefit–harm considerations, and expert consensus, the panel concluded that the risk of cardiac dysfunction is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin (moderate-quality evidence; strong recommendation). The panel recommends using an approximate ratio of 0.6 to convert daunorubicin to a doxorubicin-equivalent dose and a ratio of 10.5 for mitoxantrone (low-quality evidence; moderate recommendation). No recommendation was made for epirubicin or idarubicin due to inconclusive evidence.",

author = "Kouwenberg, \{Theodorus W.\} and \{van Dalen\}, \{Elvira C.\} and Mulder, \{Ren{\'e}e L.\} and Saro Armenian and Feijen, \{Elizabeth A.M.\} and Chow, \{Eric J.\} and Helen Kosmidis and Vormoor-B{\"u}rger, \{Britta J.\} and Chikako Kiyotani and Nathan, \{Paul C.\} and Livia Kapusta and Grotenhuis, \{Heynric B.\} and Engels, \{Frederike K.\} and Teske, \{Arco J.\} and Athanasios Tragiannidis and Slieker, \{Martijn G.\} and Shuichi Ozono and Anju Nohria and Tom{\'a}{\v s} Sl{\'a}ma and Roderick Skinner and Hudson, \{Melissa M.\} and Kremer, \{Leontien C.M.\} and Ehrhardt, \{Matthew J.\} and Mavinkurve-Groothuis, \{Annelies M.C.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors.",

year = "2025",

month = oct,

doi = "10.1016/j.jaccao.2025.05.009",

language = "English",

volume = "7",

pages = "683--690",

journal = "JACC: CardioOncology",

issn = "2666-0873",

publisher = "Elsevier Inc.",

number = "6",

}

Kouwenberg, TW, van Dalen, EC , Mulder, RL, Armenian, S, Feijen, EAM, Chow, EJ, Kosmidis, H, Vormoor-Bürger, BJ, Kiyotani, C, Nathan, PC, Kapusta, L, Grotenhuis, HB, Engels, FK, Teske, AJ, Tragiannidis, A, Slieker, MG, Ozono, S, Nohria, A, Sláma, T, Skinner, R, Hudson, MM, Kremer, LCM, Ehrhardt, MJ & Mavinkurve-Groothuis, AMC 2025, 'IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer', JACC: CardioOncology, vol. 7, no. 6, pp. 683-690. https://doi.org/10.1016/j.jaccao.2025.05.009

TY - JOUR

T1 - IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer

AU - Kouwenberg, Theodorus W.

AU - van Dalen, Elvira C.

AU - Mulder, Renée L.

AU - Armenian, Saro

AU - Feijen, Elizabeth A.M.

AU - Chow, Eric J.

AU - Kosmidis, Helen

AU - Vormoor-Bürger, Britta J.

AU - Kiyotani, Chikako

AU - Nathan, Paul C.

AU - Kapusta, Livia

AU - Grotenhuis, Heynric B.

AU - Engels, Frederike K.

AU - Teske, Arco J.

AU - Tragiannidis, Athanasios

AU - Slieker, Martijn G.

AU - Ozono, Shuichi

AU - Nohria, Anju

AU - Sláma, Tomáš

AU - Skinner, Roderick

AU - Hudson, Melissa M.

AU - Kremer, Leontien C.M.

AU - Ehrhardt, Matthew J.

AU - Mavinkurve-Groothuis, Annelies M.C.

PY - 2025/10

Y1 - 2025/10

N2 - Anthracycline and anthraquinone agents are major contributors to cancer therapy–related cardiac dysfunction in childhood cancer. However, evidence-based equivalence ratios for estimating individual risk have not been incorporated into international surveillance guidelines. The International Late Effects of Childhood Cancer Guideline Harmonization Group systematically reviewed the literature on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Based on available evidence, benefit–harm considerations, and expert consensus, the panel concluded that the risk of cardiac dysfunction is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin (moderate-quality evidence; strong recommendation). The panel recommends using an approximate ratio of 0.6 to convert daunorubicin to a doxorubicin-equivalent dose and a ratio of 10.5 for mitoxantrone (low-quality evidence; moderate recommendation). No recommendation was made for epirubicin or idarubicin due to inconclusive evidence.

AB - Anthracycline and anthraquinone agents are major contributors to cancer therapy–related cardiac dysfunction in childhood cancer. However, evidence-based equivalence ratios for estimating individual risk have not been incorporated into international surveillance guidelines. The International Late Effects of Childhood Cancer Guideline Harmonization Group systematically reviewed the literature on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Based on available evidence, benefit–harm considerations, and expert consensus, the panel concluded that the risk of cardiac dysfunction is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin (moderate-quality evidence; strong recommendation). The panel recommends using an approximate ratio of 0.6 to convert daunorubicin to a doxorubicin-equivalent dose and a ratio of 10.5 for mitoxantrone (low-quality evidence; moderate recommendation). No recommendation was made for epirubicin or idarubicin due to inconclusive evidence.

UR - https://www.scopus.com/pages/publications/105008558991

UR - https://www.mendeley.com/catalogue/ed35154f-48ac-3f19-9f8c-313883da0c65/

U2 - 10.1016/j.jaccao.2025.05.009

DO - 10.1016/j.jaccao.2025.05.009

M3 - Article

AN - SCOPUS:105008558991

SN - 2666-0873

VL - 7

SP - 683

EP - 690

JO - JACC: CardioOncology

JF - JACC: CardioOncology

IS - 6

ER -

IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer

Abstract

Access to Document

Fingerprint

Cite this