Cardiovascular mortality among patients with non‐Hodgkin lymphoma: Differences according to lymphoma subtype

Abstract

Survival rates of patients with non‐Hodgkin lymphoma (NHL) have improved over the last decade. However, cardiotoxicities remain important adverse consequences of treatment with chemotherapy and radiation, although the burden of cardiovascular mortality (CVM) in such patients remains unknown. We conducted a retrospective cohort study of patients greater than or equal to 20 years of age diagnosed with diffuse large B‐cell lymphoma (DLBCL), follicular lymphoma (FL), and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) between 2000 and 2013 using data extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. Our primary endpoint was CVM. The association between NHL and CVM was evaluated using multivariable Cox regression analysis after adjusting for other patient characteristics. We calculated standardized mortality ratios (SMRs) for CVM, comparing NHL patients with the general population. We identified 153 983 patients who met the inclusion criteria (69 329 with DLBCL, 48 650 with CLL/SLL, and 36 004 with FL). The median follow‐up was 37 months (interquartile range, 10‐78 months); the mean patient age was 66.24 (±14.69) years; 84 924 (55.2%) were men; 134 720 (87.5%) were White, and 131 912 (85.7%) did not receive radiation therapy. Overall, 9017 patients (5.8%) died from cardiovascular disease, and we found that NHL patients had a higher risk of CVM than the general population, after adjusting for age (SMR 15.2, 95% confidence interval: 14.89‐15.52). The rates of CVM were 5.1%, 8%, and 4.4% in patients with DLBCL, CLL/SLL, and FL, respectively. Furthermore, across all NHL subtypes, older age, higher stage at the time of diagnosis (particularly stage 4), male sex, and living in the south were associated with higher risks of CVM. Our data suggest that risk assessment and careful cardiac monitoring are recommended for NHL patients, particularly those with the CLL/SLL subtypes.

Cause-specific mortality after diagnosis of thyroid cancer: a large population-based study

“…Notably, multivariate analysis indicated that radiotherapy reduced CVD-specific mortality in patients with thyroid cancer. This finding seems to contrast with the known cardiotoxic effect of EBRT but is line with results from some previous studies reporting reduced risk or no excess risk of CVD death associated with EBRT [27][28][29][30]. A possible explanation is that patients who undergo radiotherapy receive more preventive cardiology care.…”

The incidence and survival outcomes of patients with primary cardiac lymphoma: A SEER‐based analysis

“…However, we hold the opinion that reducing or strengthening the intensity of chemotherapy is extreme. In clinical treatment, it is still necessary to comprehensively assess the possibility of cardiovascular death in patients by using age, staging, sex, and other factors to develop individualized chemotherapy schemes 20 …”

Cause‐specific mortality in individuals with lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia, 2000–2016

“…In contrast to infections, cardiovascular and neurological diseases – the other most common non‐cancer deaths in patients with LPL/WM (Castillo et al , ) – posed no overall increased risk of mortality compared to the general population. The borderline but not significantly elevated mortality risk (SMR 1·1) from cardiovascular diseases after LPL/WM contrasts with strikingly increased cardiovascular mortality risks among patients with other NHLs and solid cancers (Abuamsha et al , ; Sturgeon et al , ), possibly reflecting lower use of cardiotoxic agents and radiotherapy in LPL/WM. Decreased risks of neurological deaths may be due to under‐reporting of dementia as an underlying cause of death (Macera et al , ; Ganguli & Rodriguez, ; Ives et al , ; Romero et al , ), although the novel finding of elevated risk of death due to cerebrovascular diseases exclusively in patients aged <65 years at LPL/WM diagnosis correlates with the higher observed rates of symptomatic hyperviscosity among younger patients with WM (Bustoros et al , ).…”