Cardioprotection by Dexrazoxane In Adult Patients With Non-Breast Cancer With Pre-Existing Systolic Dysfunction
A 67-year-old female patient with history of non-ischemic cardiomyopathy (baseline left ventricular ejection fraction of 35%) presents with recent unintentional weight loss, night sweats, and low-grade fever. She has baseline New York Heart Association Class I heart failure (HF), and had implantable cardioverter defibrillator placement several years ago, and has been on target doses of lisinopril, carvedilol, and spironolactone without the need for a loop diuretic. Further workup with computed tomography scan of abdomen and pelvis reveal diffuse lymphadenopathy. Based on biopsy of an affected lymph node, she is diagnosed with stage III-B Hodgkin's lymphoma with high-risk features. Anthracycline-based chemotherapy is thought to have greatest curative potential; however, given her preexisting cardiomyopathy, she is considered very high risk for development of worsened HF with use of anthracyclines. Her physical examination is unremarkable; she appears euvolemic.
Which of the following is the most efficient strategy for cardioprotection?