Doxorubicin-based chemotherapy for aggressive non-Hodgkin lymphoma markedly increased the long-term risk of chronic heart failure compared to the general population (SIR 5.4; 95% CI 4.1-6.9).
Cohort (n=476)
Yes
Does doxorubicin-based chemotherapy for aggressive NHL increase the long-term risk of cardiovascular disease compared to the general population?
Patients treated with doxorubicin-based chemotherapy for aggressive NHL have a significantly increased long-term risk of chronic heart failure and stroke, necessitating life-long monitoring, while their risk of coronary artery disease matches the general population.
Effect estimate: SIR 5.4 (95% CI 4.1-6.9)
Cardiovascular disease frequently occurs after lymphoma therapy, but it is common in the general population too. Therefore, risk estimation requires comparison to population-based rates. We calculated risk by standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10,000 person-years based on general population rates (Continuous Morbidity Registry Nijmegen) in 476 (Dutch and Belgian) patients with aggressive non-Hodgkin lymphoma (NHL) treated with at least 6 cycles of doxorubicin-based chemotherapy in 4 European Organization for Research on Treatment of Cancer (EORTC) trials (1980-1999). Cumulative incidence of cardiovascular disease, estimated in a competing risk model, was 12% at 5 years and 22% at 10 years (median follow-up, 8.4 years). Risk of chronic heart failure appeared markedly increased (SIR, 5.4; 95% CI, 4.1-6.9) with an AER of 208 excess cases per 10 000 person-years, whereas risk of coronary artery disease matched the general population (SIR, 1.2; 95% CI, 0.8-1.8; AER, 8 per 10 000 person-years). Risk of stroke was raised (SIR, 1.8; 95% CI, 1.1-2.4; AER, 15 per 10 000 person-years), especially after additional radiotherapy (> 40 Gy). Preexisting hypertension, NHL at young age, and salvage treatment increased risk of all cardiovascular events; the effect of radiotherapy was dose dependent. In conclusion, patients are at long-term high risk of chronic heart failure after NHL treatment and need therefore life-long monitoring. In contrast, risk of coronary artery disease appeared more age dependent than treatment related.
E. C. Moser (Fri,) conducted a cohort in Aggressive non-Hodgkin lymphoma (n=476). Doxorubicin-based chemotherapy vs. General population was evaluated on Chronic heart failure (SIR 5.4, 95% CI 4.1-6.9). Doxorubicin-based chemotherapy for aggressive non-Hodgkin lymphoma markedly increased the long-term risk of chronic heart failure compared to the general population (SIR 5.4; 95% CI 4.1-6.9).
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