What is the clinical evidence from this study?

Study design: Observational. Population: Non-Hodgkin lymphoma (n=35). Intervention: CHOP chemotherapy vs. Pre-chemotherapy baseline. Primary outcome: High-sensitivity troponin T (hsTnT) level (pg/ml) (p=<0.001).

October 19, 2020Open Access

High Sensitivity Troponin T as Complementary Modality for Determining Doxorubicin Regimen Cardiotoxicity in Non-Hodgkin Lymphoma Patients

Q: What are the key findings of this study?

In non-Hodgkin lymphoma patients receiving CHOP chemotherapy, high-sensitivity troponin T levels significantly increased after four cycles (median 5.1 to 10.1 pg/ml, p<0.001), detecting myocardial injury in 28.6% of patients.

Key Result

In non-Hodgkin lymphoma patients receiving CHOP chemotherapy, high-sensitivity troponin T levels significantly increased after four cycles (median 5.1 to 10.1 pg/ml, p<0.001), detecting myocardial injury in 28.6% of patients.

Study Design

Type

Observational (n=35)

Multicenter

Structured PICO

Does high-sensitivity troponin T complement LVEF in detecting doxorubicin-induced cardiotoxicity in adult patients with non-Hodgkin lymphoma receiving CHOP chemotherapy?

Population

35 adults (>18 years) diagnosed with non-Hodgkin lymphoma (NHL) receiving CHOP chemotherapy. Exclusions: history of myocardial infarction, diabetes mellitus, chronic kidney disease, liver cirrhosis, and prior chemotherapy or radiotherapy.

Intervention

CHOP chemotherapy regimen (750 mg/m2 IV cyclophosphamide, 50 mg/m2 IV doxorubicin, 1.4 mg/m2 IV vincristine, and 100 mg oral prednisone days 1-5) for 4 cycles, reaching a cumulative doxorubicin dose of 200 mg/m2.

Outcome

Changes in left ventricular ejection fraction (LVEF) and high-sensitivity troponin T (hsTnT) measured before the first cycle and after the fourth cycle of chemotherapy.surrogate

High-sensitivity troponin T detects subclinical myocardial injury in a significant proportion of NHL patients receiving doxorubicin, complementing LVEF which may only show minor, clinically covert functional changes.

Main Result

Absolute Event Rate: 10.1% vs 5.1%

p-value: p=<0.001

Limitations

Small sample size due to a limited study period
Did not uniformize the moment of taking blood samples after the 4th cycle of chemotherapy
Did not assess other medications taken during the study that could create bias in LVEF measurement
Did not impose an upper limit for patient age

Abstract

Purpose: This study aims to evaluate the role of high-sensitivity troponin T (hsTnT) as a complementary tool for determining cardiotoxicity in non-Hodgkin lymphoma (NHL) patients receiving cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) regimen chemotherapy. Methods: We included 35 patients diagnosed with NHL who received CHOP chemotherapy. Left ventricular ejection fraction (LVEF) and hsTnT were measured at two time points: before the first cycle (pre-test) and after the fourth cycle (post-test). The LVEF and hsTnT were analysed using IBM SPSS version 24 through the paired-sample T-test, Wilcoxon signed-rank test, Pearson’s correlation and Spearman’s correlation. Results: There was a significant difference in both LVEF and hsTnT between pre-chemotherapy and post-4th chemotherapy cycles (p = 0.001). However, more contrast difference from the baseline value of hsTnT compared to LVEF could be observed. LVEF did not detect any deterioration in myocardial function. However, 10 out of 35 subjects exhibit hsTnT higher than the 99th percentile of the population (>14 pg/ml), suggesting that myocardial injury (MI) could be detected. There was no correlation between LVEF and hsTnT (p > 0.05). Conclusion: HsTnT, together with LVEF, could complement each other and offer better coverage for detecting cardiotoxicity during the administration of CHOP in NHL patients. An insignificant correlation between hsTnT and LVEF showed that cardiotoxicity existed in a broad spectrum including cellular damage and functional impairment, as hsTnT represents cellular damage, and LVEF reflects heart functional capacity.

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Cite This Study

Ashariati et al. (Mon,) conducted a observational in Non-Hodgkin lymphoma (n=35). CHOP chemotherapy vs. Pre-chemotherapy baseline was evaluated on High-sensitivity troponin T (hsTnT) level (pg/ml) (p=<0.001). In non-Hodgkin lymphoma patients receiving CHOP chemotherapy, high-sensitivity troponin T levels significantly increased after four cycles (median 5.1 to 10.1 pg/ml, p<0.001), detecting myocardial injury in 28.6% of patients.

synapsesocial.com/papers/6a12065d86b31d97fdb4cd70 https://doi.org/https://doi.org/10.34172/apb.2022.017

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