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To the Editor:
Mitoxantrone (MiTX) reduces relapse frequency and MRI evidence of disease activity in relapse-onset multiple sclerosis (MS). MiTX is a toxic agent that must be carefully administered to reduce the likelihood of bone marrow suppression, opportunistic infection, leukemia, and cardiomyopathy. The risk of cardiomyopathy is generally assumed to be dose dependent. Dörr et al.1 suggest that toxic cardiomyopathy may occur after a relatively low dose (i.e., 2 infusions) given very early after treatment is initiated. This challenges the assumption that MiTX given below a certain cumulative dose can be considered safe regarding the risk of heart failure.
We present a case of severe heart failure that occurred 26 months after the final (sixth) infusion of MiTX in a 48-year-old woman with RRMS. The total cumulative dose had only been 72 mg/m2 (12 mg/m2 body …
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