The effects of cardiovascular disease on the clinical outcome of elderly patients with diffuse large B-cell lymphoma

Abstract

We identified 3910 elderly (>65 yrs) patients with diffuse large B-cell lymphoma (DLBCL) who received doxorubicin-based (+/−rituximab) therapy and 77 347 cancer-free controls, and assessed cardiovascular events and survival in relation to preexisting cardiovascular comorbidities. Compared to controls, patients with DLBCL had a 3.4-fold (95%CI 3.0–3.9) and 2.5-fold (95%CI 2.3–2.7) increased risk of congestive heart failure (CHF)/cardiomyopathy (CM) within 6 months and 3 years of diagnosis, respectively. Risk of acute myocardial infarction (AMI) was similarly increased. The risk of CHF/CM and AMI was significantly higher in those patients with DLBCL (vs. controls) who did not report preexisting cardiovascular disease, compared to those who had preexisting cardiovascular disease; this was due to dose reductions of doxorubicin among patients with preexisting cardiovascular disease. Rituximab improved survival in patients with stage III–IV (but not I–II) disease (p-interaction = 0.0003). Our novel findings emphasize the need to reduce cardiac toxicity of doxorubicin in elderly DLBCL patients.

Keywords::

• Cardiovascular disease
• doxorubicin
• rituximab
• elderly cardiac failure
• prognosis
• survival
• outcome

Acknowledgements

This research was supported by the Intramural Program of the NCI.

Potential conflict of interest

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