Cardiovascular outcomes of patients treated for non-Hodgkin lymphoma with first-line doxorubicin-based chemotherapy

Abstract

We conducted a single-center retrospective study to assess cardiovascular (CV) toxicity and treatment discontinuation for CV toxicity in diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) patients treated with immunochemotherapy (R-CHOP-like). Between 2006 and 2017, 433 patients were included (DLBCL: n = 345, FL: n = 88). The median age was 63 years (50–73). We defined three types of CV toxicity: early-onset cardiovascular toxicity (the event occurred within 6 months following treatment start); subacute toxicity (the event occurred between 6 months and 1 year after treatment start) and late toxicity (the event occurred 1 year or more after treatment start). Forty-eight (11.1%) patients experienced at least one anthracycline-related CV event. Seven patients experienced treatment discontinuation due to CV toxicity. Early-onset and subacute cardiac events were primarily acute heart failure (34.3%) and atrial fibrillation (28.6%). History of ischemic heart disease (p = 0.02) and valvular heart disease (p = 0.03) were associated with a higher risk of anthracycline-related CV event occurrence.

Keywords:

• Cardiovascular toxicity
• doxorubicin-induced cardiotoxicity
• doxorubicin
• lymphoma
• DLBCL
• immunochemotherapy
• R-CHOP

Acknowledgments

We would like to thank Mrs. Julie LIBRAIRE and Mrs. Doriane RICHARD, who provided administrative support. We would like to thank Mrs. Justine LORET, Laure GAILLON and Laure SULPICE for their support in clinical data collection. We would also like to thank Dr. Valery BRUNEL, who provided support for the troponin and NTproBNP retrospective assessment. The authors wish to thank the Biological Resource Center (CRB – Rouen) and the Department of Oncology Genetics of the Henri Becquerel Center for the processing of the samples.

Ethics approval

This retrospective study was approved by the Center Henri Becquerel internal review board (N°1910B).

Consent to participate

Patient’s statement of consent was obtained for all live participants.

Consent for publication

We give the Publisher the permission of the Authors to publish the work. Availability of data and material: All data are available for review upon request to the corresponding author. Code availability (software application or custom code): not applicable

Authors’ contributions

AZ performed data collection, interpreted the data and wrote the manuscript. EL performed statistical analysis. LFP analyzed and interpreted the data. AP and PE performed NTproBNP and troponin analyses. VC designed the study, interpreted the data, coordinated the work and edited the manuscript. AZ, ALM, PL, NC, SL, EL, HL, AS, LKQ, HT, FB, and FJ were involved in the care of the patients. All authors read and approved the manuscript.

Disclosure statement

No relevant conflict of interest to disclose.

Additional information

Funding

This work was supported by the iQone Healthcare.