Cardiovascular adverse events associated with cyclophosphamide, pegylated liposomal doxorubicin, vincristine, and prednisone with or without rituximab ((R)-CDOP) in non-Hodgkin’s lymphoma: A systematic review and meta-analysis

Abstract

Background: The (R)-CDOP combination regimen, based on pegylated liposomal doxorubicin, is increasingly used for elderly patients with non-Hodgkin’s lymphoma. However, the cardiotoxicity and efficacy of the (R)-CDOP regimen compared with conventional anthracyclines have not been demonstrated in the general population. Therefore, this systematic review and meta-analysis evaluated the risk of cardiotoxicity and efficacy associated with the (R)-CDOP regimen in patients with non-Hodgkin’s lymphoma.Methods: PubMed, Embase, Cochrane Library, CNKI, WanFang Database, and VIP were searched. The search covered the period from the start of the clinical use of (R)-CDOP to April 2022. We searched the literature for cardiovascular adverse events associated with (R)-CDOP in non-Hodgkin’s lymphoma. The data were analyzed using R 4.2.0 and Stata 12.0.Results: From the included studies, the important findings were as follows: total cardiovascular event rate, 7.45% (95% confidence interval [CI] = 4.86%–10.44%); non-serious cardiovascular adverse event rate, 6.48% (95% CI = 3.70%–9.8%); serious cardiovascular adverse event rate, 0.67% (95% CI = 0.00%–2.12%); heart failure rate, 0.55% (95% CI = 0.00%–1.93%); rate of treatment discontinuation attributable to left ventricular dysfunction or heart failure, 0.02% (95% CI = 0.00%–0.57%); and cardiovascular death rate, 0.00% (95% CI = 0.00%–0.37%). Compared with the (R)-CHOP regimen, the (R)-CDOP regimen reduced the risk of cardiovascular events, including total cardiovascular adverse events (odds ratio [OR] = 0.161, 95% CI = 0.103–0.251, p < 0.001, and NNT = 3.7), non-serious cardiovascular adverse events (OR = 0.171, 95% CI = 0.093–0.314, p < 0.001, and NNT = 3.6), serious cardiovascular adverse events (OR = 0.252, 95% CI = 0.119–0.535, p < 0.001, and NNT = 6.8), and heart failure (OR = 0.294, 95% CI = 0.128–0.674, p = 0.004, and NNT = 9.5). To evaluate the survival benefits, we compared (R)-CDOP and (R)-CHOP regimens. We found that the (R)-CDOP regimen was no less efficacious, including complete remission (CR) (OR = 1.398, 95% CI = 0.997–1.960, and p = 0.052), partial response (PR) (OR = 1.631, 95% CI = 1.162–2.289, and p = 0.005), objective response rate (ORR) (OR = 2.236, 95% CI = 1.594–3.135, and p < 0.001), stable disease (SD) (OR = 0.526, 95% CI = 0.356–0.776, and p = 0.001), and progressive disease (PD) (OR = 0.537, 95% CI = 0.323–0.894, and p = 0.017).Conclusion: Our findings suggested that the (R)-CDOP regimen had a lower risk of cardiovascular adverse events in non-Hodgkin’s lymphoma than the (R)-CHOP regimen, demonstrating its safety with regard to cardiotoxicity. In addition, this study found the (R)-CDOP regimen was no less efficacious than the (R)-CHOP regimen in the treatment of non-Hodgkin’s lymphoma. These findings need to be validated by higher-quality research because of the limited number and quality of included studies.

Primary lymphoma of the female genital tract masquerading as gynecological malignancy

“…In our study, 10 patients received chemotherapy, 9 received R-CHOP regimen with the median survival time of 38 months (ranging from 1 to 102 months), and 1 received R-CDOP regimen with survival time of 33 months. Some researchers [ 34 , 35 ] reported that compared with R-CHOP regimen, R-CDOP regimen carried lower risks of adverse effects and non-serious cardiovascular events, and its efficacy was basically the same as that of R-CHOP regimen. As in our study, one patient who received the R-CDOP regimen, which may be related to the complication of hypertension and CHD complications.…”

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

“…In hematological malignancies, most data exist regarding comparisons of R-CHOP versus R-COMP in lymphoma, mainly DLBCL (diffuse large B cell lymphoma). [31][32][33][34][35][36] In patients at high baseline CV risk, such as older patients, pre-existing CVD or previous high doses of anthracyclines, liposomal anthracyclines have shown similar efficacy with reduced cardiotoxicity, making them a valuable therapeutic option in these patients. [31][32][33][34][35][36][37][38][39] A translational study of our group demonstrated less cardiotoxicity of liposomal doxorubicin in an experimental setting.…”

“…[31][32][33][34][35][36] In patients at high baseline CV risk, such as older patients, pre-existing CVD or previous high doses of anthracyclines, liposomal anthracyclines have shown similar efficacy with reduced cardiotoxicity, making them a valuable therapeutic option in these patients. [31][32][33][34][35][36][37][38][39] A translational study of our group demonstrated less cardiotoxicity of liposomal doxorubicin in an experimental setting. 40 Importantly, patients with high baseline CV risk about to receive anthracyclines should be considered for initiation of beta-blockers and ACEi/ARB (Class IIa, Level B).…”

Assessment of Clinical and Diagnostic Indicators of Cardiovascular Toxicity in Patients with Non-Hodgkin’s Lymphomas in the Course of Programmatic Antitumor Therapy

“…Все пациенты в ходе исследования были поделены на две группы: основную составили пациенты с проявлениями КТ (21 пациент, средний возраст 55,2 (9,8) (M (SD)) лет, из них мужчин -16 (76,2 %)), контрольную -без сердечно-сосудистых осложнений (51 пациент, средний возраст 53,7 (13,6) лет, из них 21 (41,2 %) мужчин). Согласно мнению Российских экспертов по профилактике, диагностике и лечению сердечно-сосудистой токсичности (2021), КТ верифицируется в случаях снижения фракции выброса левого желудочка (ФВ ЛЖ) >10 % от исходного уровня или в абсолютном выражении менее, чем 53 % и/или снижения продольной систолической деформации левого желудочка (ПД ЛЖ) >12 % от исходного уровня [4].…”