Diffuse large B-cell lymphoma survivors face a 3.9-fold higher heart failure risk than the general population, with >300 mg/m2 doxorubicin increasing cardiomyopathy risk 2.8-fold.
Does radiotherapy and anthracycline-based chemotherapy increase the risk of cardiovascular diseases in DLBCL survivors compared to the general population?
DLBCL survivors treated with anthracyclines and radiotherapy face a significantly elevated long-term risk of heart failure, particularly females and those treated at younger ages, warranting individualized cardiac screening.
Abstract Background Few studies examined treatment-specific long-term risks of cardiovascular diseases (CVD) in diffuse large B-cell lymphoma (DLBCL) survivors treated with potentially cardiotoxic radiotherapy and/or chemotherapy with/without rituximab after the 1990s. Methods Long-term CVD risk was examined in a multicenter cohort comprising 2,356 ≥ 5-year DLBCL survivors treated at ages 15 to 61 years in 1989 to 2012. CVD data were acquired from medical records, general practitioners and disease-registries. Observed CVD-numbers were compared with expected CVD-incidence in the Dutch population to estimate standardized incidence ratios (SIRs) and absolute excess risks (AERs/10,000 person-years). Treatment-specific CVD risks were assessed using multivariable Cox regression. Results During a median follow-up of 14.2 years (IQR 10.1 to 18.9), 312 survivors were diagnosed with a first CVD ≥5 years after treatment. Compared with the general population, DLBCL survivors had increased risks of heart failure (HF, SIR 3.9, 95%CI 3.4-4.6, AER 62.8) and cerebrovascular accident (SIR 1.3, 95%CI 1.0 to 1.7, AER 9.8), while risk of coronary artery disease was decreased (SIR 0.7, 95%CI 0.5-0.9, AER -30.9). HF risk was higher among females (SIR 5.3, 95%CI 4.2 to 6.5) than males (SIR 3.2, 95%CI 2.6-4.0, P heterogeneity0.001), and among survivors ≤40 years at DLBCL treatment (SIR 10.5, 95%CI 7.2 to 14.8, P trend0.001). Exposure to 300 mg/m2 doxorubicin was associated with a 2.8-fold (95%CI 1.7-4.5) increased risk of cardiomyopathy/HF, while radiotherapy involving the heart was associated with a 1.9-fold (95%CI 1.1 to 3.1) increased risk of valvular heart disease. Conclusion ≥5-year DLBCL survivors have increased risks of developing CVDs, especially HF. Physicians and patients should recognize this risk, and individualized cardiac screening should be considered.
Geurts et al. (2026) studied this question. Diffuse large B-cell lymphoma survivors face a 3.9-fold higher heart failure risk than the general population, with >300 mg/m2 doxorubicin increasing cardiomyopathy risk 2.8-fold.