Key result
Elderly DLBCL patients receiving doxorubicin-based therapy had a 3.4-fold increased risk of heart failure or cardiomyopathy within 6 months compared to cancer-free controls (RR 3.4; 95% CI 3.0-3.9).
Why the study?
Does doxorubicin-based therapy increase the risk of cardiovascular events in elderly patients with diffuse large B-cell lymphoma compared to cancer-free controls?
Cohort (n=81,257)
Does doxorubicin-based therapy increase the risk of cardiovascular events in elderly patients with diffuse large B-cell lymphoma compared to cancer-free controls?
Relative Risk: 3.4 (95% CI 3–3.9)
Elderly patients with DLBCL receiving doxorubicin-based therapy have a significantly increased risk of heart failure and myocardial infarction compared to cancer-free controls, highlighting the need for strategies to reduce cardiac toxicity.
Supports cardiac monitoring in elderly DLBCL patients on doxorubicin; leaves open optimal cardioprotection strategies for randomized evaluation.
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.
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Tsai et al. (2014) conducted a cohort in Diffuse large B-cell lymphoma (DLBCL) (n=81,257). Doxorubicin-based therapy in DLBCL vs. Cancer-free controls was evaluated on Congestive heart failure (CHF)/cardiomyopathy (CM) within 6 months (RR 3.4, 95% CI 3.0-3.9). Elderly DLBCL patients receiving doxorubicin-based therapy had a 3.4-fold increased risk of heart failure or cardiomyopathy within 6 months compared to cancer-free controls (RR 3.4; 95% CI 3.0-3.9).
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