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. 2021 Aug 1;96(8):979-988.
doi: 10.1002/ajh.26230. Epub 2021 May 27.

Anthracycline treatment, cardiovascular risk factors and the cumulative incidence of cardiovascular disease in a cohort of newly diagnosed lymphoma patients from the modern treatment era

Nicholas J Boddicker  1 , Melissa C Larson  1 , Alessia Castellino  2 , Joerg Herrmann  3 , David J Inwards  4 , Gita Thanarajasingam  4 , Matthew J Maurer  1 , Cristine Allmer  1 , Thomas E Witzig  4 , Grzegorz S Nowakowski  4 , Thomas M Habermann  4 , Hector R Villarraga  3 , Susan L Slager  1 , James R Cerhan  1 , Carrie A Thompson  4
Affiliations

Anthracycline treatment, cardiovascular risk factors and the cumulative incidence of cardiovascular disease in a cohort of newly diagnosed lymphoma patients from the modern treatment era

Nicholas J Boddicker et al. Am J Hematol. .

Abstract

The development of cardiovascular disease (CVD) in long-term survivors of lymphoma is of increasing importance. Here, we characterize the cumulative incidence and risk factors for CVD in lymphoma patients diagnosed in the current treatment era. From 2002-2015, newly diagnosed lymphoma patients (>18 years) were enrollment into a prospective cohort study that captured incident CVD, consisting of congestive heart failure (CHF), acute coronary syndrome (ACS), valvular heart disease (VHD), and arrhythmia. The cumulative incidence of CVD was calculated with death modeled as a competing risk. We estimated the association of treatment with anthracyclines or radiotherapy and traditional CVD risk factors with incidence of CVD using hazard ratios (HR) and 95% confidence intervals (CI) estimated from Cox regression. After excluding prevalent CVD at lymphoma diagnosis, the study consisted of 3063 patients with a median age of 59 years (range 18-95). The cumulative incidence of CVD at 10-years was 10.7% (95% CI, 9.5%-12.1%). In multivariable analysis, increasing age (HR = 1.05 per year, p < 0.001), male sex (HR = 1.36, p = 0.02), current smoker (HR = 2.10, p < 0.001), BMI > 30 kg/m2 (HR = 1.45, p = 0.01), and any anthracycline treatment (HR = 1.57, p < 0.001) were all significantly associated with risk of CVD. Anthracyclines were associated with increased risk of CHF (HR = 2.71, p < 0.001) and arrhythmia (HR = 1.61, p < 0.01), but not VHD (HR = 0.84, p = 0.58) or ACS (HR = 1.32, p = 0.24) after adjustment for CVD risk factors. Even in the modern treatment era, CVD remains common in lymphoma survivors and preventive efforts are required that address both treatment and CVD risk factors.

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Conflict of interest statement

Competing Interests:

The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Cumulative incidence of any cardiovascular disease event (A) and by specific cardiovascular disease event endpoints (B) with all-cause mortality as a competing risk. Number at risk to be added to Figure 1B [Table: see text]
Figure 2.
Figure 2.
Risk of cardiovascular disease overall and by cardiovascular disease endpoint by the number of cycles of anthracyclines, adjusted for age, sex, diabetes, body mass index, smoking status, hyperlipidemia, hypertension, and radiation. ACS: acute coronary syndrome, CHF: congestive heart failure, VHD: valvular heart disease
See this image and copyright information in PMC

References

    1. Teras LR, DeSantis CE, Cerhan JR, Morton LM, Jemal A, Flowers CR. 2016 US lymphoid malignancy statistics by World Health Organization subtypes. CA: A Cancer Journal for Clinicians. 2016;66(6):443–459. - PubMed
    1. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375–2390. - PMC - PubMed
    1. Thun MJ, Linet MS, Cerhan JR, Haiman C, Schottenfeld D. Schottenfeld and Fraumeni cancer epidemiology and prevention (ed Fourth edition.). New York, NY: Oxford University Press; 2018.
    1. Herrmann J Adverse cardiac effects of cancer therapies: cardiotoxicity and arrhythmia. Nat Rev Cardiol. 2020;17(8):474–502. - PMC - PubMed
    1. Andre M, Mounier N, Leleu X, et al. Second cancers and late toxicities after treatment of aggressive non-Hodgkin lymphoma with the ACVBP regimen: a GELA cohort study on 2837 patients. Blood. 2004;103(4):1222–1228. - PubMed

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