Key result
Blunted early post-anthracycline lymphocyte decline is linked to ~96% higher odds of CTRCD.
Why the study?
Whether early treatment-related lymphocyte dynamics are associated with cancer therapy-related cardiac dysfunction after anthracycline therapy, and whether they add incremental value beyond clinical characteristics, was uncertain.
Does a less pronounced early decline in lymphocyte percentage predict subsequent cancer therapy-related cardiac dysfunction in anthracycline-treated adults?
Cohort (n=362)
Does a less pronounced early decline in lymphocyte percentage predict subsequent cancer therapy-related cardiac dysfunction in anthracycline-treated adults?
A less pronounced early decline in lymphocyte percentage within 30 days of anthracycline initiation is associated with higher odds of subsequent cancer therapy-related cardiac dysfunction and modestly improves risk discrimination beyond clinical variables.
May flag higher CTRCD risk during anthracycline therapy; hypothesis-generating and should not yet change surveillance practice.
Background: Whether early treatment-related lymphocyte dynamics are associated with cancer therapy?related cardiac dysfunction (CTRCD) after anthracycline therapy is uncertain. This study sought to determine the association between early change in lymphocyte and subsequent CTRCD and to assess its incremental value beyond clinical characteristics. Methods: We retrospectively studied anthracycline-treated adults in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database with linked echocardiographic data (MIMIC-IV-Echo). The primary exposure was relative change in lymphocyte percentage from baseline to the 0?30-day nadir. CTRCD was defined as a left ventricular ejection fraction (LVEF) decline ?10 percentage points to <53%. Associations were modeled using multivariable logistic regression with restricted cubic splines. Incremental discrimination was assessed using optimism-corrected AUCs. Results: Among 362 patients in the analysis cohort, 58 (16.0%) developed CTRCD. Baseline lymphocyte measures were not associated with CTRCD. Early lymphocyte percentage change was associated with CTRCD (overall P=0.031). Compared with the median change (?73%), a less pronounced decline at the 90th percentile (?5%) was associated with higher odds of CTRCD (OR: 1.96; 95% CI: 1.12?3.42; P=0.018). The association remained consistent after sequential and hematologic adjustment. Added to a clinical model that included hemoglobin and immature granulocyte percentage, lymphocyte change increased the apparent AUC from 0.705 to 0.724 and the optimism-corrected AUC from 0.644 to 0.658 (P = 0.040). Conclusions: A less pronounced early decline in lymphocyte percentage after anthracycline initiation was associated with higher odds of subsequent CTRCD and provided modest incremental information beyond clinical characteristics.
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Zhang et al. (2026) conducted a cohort in Cancer therapy-related cardiac dysfunction (CTRCD) in patients receiving anthracycline therapy (n=362). Less pronounced early decline in lymphocyte percentage (90th percentile, -5% from baseline to 0-30-day nadir) vs. Median change in lymphocyte percentage (-73% from baseline to 0-30-day nadir) was evaluated on Cancer therapy-related cardiac dysfunction (CTRCD), defined as an LVEF decline ≥10 percentage points to <53% (OR 1.96, 95% CI 1.12-3.42, p=0.018). A less pronounced early lymphocyte decline (-5% vs -73% median) after anthracyclines was associated with higher odds of CTRCD (OR 1.96; 95% CI 1.12-3.42; P=0.018).
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