{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:48:27Z","timestamp":1792414107082,"version":"4.4.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many effective anti-cancer modalities potentially induce cardiotoxicity. Pediatric patients with relapsed\/refractory hematologic malignancies are often excluded from anthracycline-containing regimens based on historical data showing population-level risk of heart failure after cumulative doses of anthracyclines without considering individual patient risk variability, modernized cumulative anthracycline equivalence ratios, novel anthracycline formulations, and use of supportive cardio-protectant medications. Additionally, standard guidelines are lacking for patients with a history of prior cardiotoxicity or previous anthracycline exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Therapeutic Advances in Childhood Leukemia and Lymphoma (TACL) consortium convened a task force to review the relevant literature and create evidence-based cardiac eligibility recommendations for patients who enroll on TACL relapse clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Recommendations for assessment of cardiotoxicity risk, cardiac monitoring, supportive care, management of cardiac dysfunction during therapy, and considerations for clinical trial design were created. Key guidance includes: 1) excluding potential subjects from therapies with cardiotoxic risk should be based on individual risk factors and real-time cardiac function assessments rather than past cardiotoxic exposures; 2) comprehensive subject-based cardiac monitoring before, during and after therapy is essential; 3) the liberal use of cardioprotective measures is encouraged; 4) uniform and evidence-based approaches for management of cardiac dysfunction during protocol therapy are crucial; 5) correlative cardiac aims should accompany protocols with potentially cardiotoxic therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adoption of these updated recommendations should allow more accurate and inclusive study eligibility criteria for TACL\u2019s clinical trials and inform future trial development while ultimately improving both quality and interpretability of study data, patient safety, treatment, and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag393","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:33:26Z","timestamp":1792413206000},"source":"Crossref","is-referenced-by-count":0,"title":["Cardio-protection and monitoring for early phase clinical trials: Recommendations from the therapeutic advances in childhood leukemia and lymphoma (TACL) consortium"],"prefix":"10.1093","author":[{"given":"Susan I","family":"Colace","sequence":"first","affiliation":[{"name":"Nationwide Children\u2019s Hospital Division of Hematology, Oncology and Blood and Marrow Transplant, , Columbus, OH,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Pommert","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital Medical Center Division of Oncology, Cancer and Blood Diseases Institute, , Cincinnati, OH,","place":["USA"]},{"name":"University of Cincinnati College of Medicine Department of Pediatrics, , Cincinnati, OH,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasey J","family":"Leger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine Cancer and Blood Disorders Center, Seattle Children's Hospital, , Seattle, WA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Rushing","sequence":"additional","affiliation":[{"name":"Children's Hospital Los Angeles Cancer and Blood Disease Institute, Department of Pediatrics, , Los Angeles, CA,","place":["USA"]},{"name":"Children's Hospital Los Angeles Department of Pharmacy, , Los Angeles, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine R","family":"Crews","sequence":"additional","affiliation":[{"name":"St. Jude Children's Research Hospital Department of Pharmacy and Pharmaceutical Sciences, , Memphis, TN,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Annesley","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine Cancer and Blood Disorders Center, Seattle Children's Hospital, , Seattle, WA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Brooke","family":"Bernhardt","sequence":"additional","affiliation":[{"name":"St. Jude Children's Research Hospital Department of Pharmacy and Pharmaceutical Sciences, , Memphis, TN,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B","family":"Ramsey","sequence":"additional","affiliation":[{"name":"Children\u2019s Mercy, Kansas City, Department of Pediatrics, University of Missouri Kansas City Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, , MO,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Colorado Department of Pharmacy, , Aurora, CO,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepa","family":"Bhojwani","sequence":"additional","affiliation":[{"name":"University of Southern California USC Norris Comprehensive Cancer Center, Keck School of Medicine, , Los Angeles, California,","place":["USA"]},{"name":"Children\u2019s Hospital Los Angeles Cancer and Blood Disease Institute, , Los Angeles, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S","family":"Wayne","sequence":"additional","affiliation":[{"name":"University of Southern California USC Norris Comprehensive Cancer Center, Keck School of Medicine, , Los Angeles, California,","place":["USA"]},{"name":"Children\u2019s Hospital Los Angeles Cancer and Blood Disease Institute, , Los Angeles, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine Cancer and Blood Disorders Center, Seattle Children's Hospital, , Seattle, WA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan R","family":"Rheingold","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, , Philadelphia, PA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew E","family":"Place","sequence":"additional","affiliation":[{"name":"Harvard Medical School Dana-Farber\/Boston Children\u2019s Cancer and Blood Disorders Center, , Boston, MA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bill H","family":"Chang","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University Division of Pediatric Hematology Oncology, , Portland, OR,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Sulis","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center Department of Pediatric Oncology, , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda","family":"Pauly","sequence":"additional","affiliation":[{"name":"Aflac Cancer and Blood Disorders Center, Children\u2019s Healthcare of Atlanta , Atlanta, GA,","place":["USA"]},{"name":"Emory University School of Medicine , Department of Pediatrics, Atlanta, GA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S","family":"Gaynon","sequence":"additional","affiliation":[{"name":"University of Southern California USC Norris Comprehensive Cancer Center, Keck School of Medicine, , Los Angeles, California,","place":["USA"]},{"name":"Children\u2019s Hospital Los Angeles Cancer and Blood Disease Institute, , Los Angeles, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine , Department of Pediatrics, Atlanta, GA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S","family":"Schafer","sequence":"additional","affiliation":[{"name":"Emory University and Children's Healthcare of Atlanta Division of Cardiology, Department of Pediatrics, , GA,","place":["USA"]},{"name":"Baylor College of Medicine Department of Pediatrics, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himalee S","family":"Sabnis","sequence":"additional","affiliation":[{"name":"Aflac Cancer and Blood Disorders Center, Children\u2019s Healthcare of Atlanta , Atlanta, GA,","place":["USA"]},{"name":"Emory University School of Medicine , Department of Pediatrics, Atlanta, GA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,19]]},"container-title":["JNCI: Journal of the National Cancer 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