Clinical features of anthracycline‐induced cardiotoxicity in patients with malignant lymphoma who received a CHOP regimen with or without rituximab: A single‐center, retrospective observational study

Abstract

We investigated the incidence of cardiotoxicity, its risk factors, and the clinical course of cardiac function in patients with malignant lymphoma (ML) who received a cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) regimen. Among all ML patients who received a CHOP regimen with or without rituximab from January 2008 to December 2017 in Nagoya City University hospital, 229 patients who underwent both baseline and follow‐up echocardiography and had baseline left ventricular ejection fraction (LVEF) ≥50% were analyzed, retrospectively. Cardiotoxicity was defined as a ≥10% decline in LVEF and LVEF < 50%; recovery from cardiotoxicity was defined as a ≥5% increase in LVEF and LVEF ≥50%. Re‐cardiotoxicity was defined as meeting the criteria of cardiotoxicity again. With a median follow‐up of 1132 days, cardiotoxicity, symptomatic heart failure, and cardiovascular death were observed in 48 (21%), 30 (13%), and 5 (2%) patients, respectively. Multivariate analysis demonstrated that history of ischemic heart disease (hazard ratio (HR), 3.15; 95% CI, 1.17‐8.47, P = .023) and decreased baseline LVEF (HR per 10% increase, 2.55; 95% CI, 1.49‐4.06; P < .001) were independent risk factors for cardiotoxicity. Recovery from cardiotoxicity and re‐cardiotoxicity were observed in 21 of 48, and six of 21, respectively. Cardiac condition before chemotherapy seemed to be most relevant for developing cardiotoxicity. Furthermore, Continuous management must be required in patients with cardiotoxicity, even after LVEF recovery.

Ventricular Sigmoid Septum as a Risk Factor for Anthracycline-Induced Cancer Therapeutics-Related Cardiac Dysfunction in Patients with Malignant Lymphoma

“…Lower LVEF and smaller GLS in patients with normal LVEF were already recognized as risk factors for anthracycline-induced CTRCD. 11,13,14,18 In the current study, LVEF was not an independent determinant for anthracycline-induced CTRCD in the multivariable analysis, probably because GLS can detect myocardial injury more sensitively than LVEF. 34,35 History of ischemic heart disease is also considered a risk factor for CTRCD.…”

“…Patients with LVEF < 50% at baseline but no echocardiographic images of adequate quality were excluded. The current study was the sub-analysis of a previous study in which we described the clinical features of anthracycline-induced CTRCD 18 .…”

Ventricular Sigmoid Septum as a Risk Factor for Anthracycline-Induced Cancer Therapeutics-Related Cardiac Dysfunction in Patients With Malignant Lymphoma

“…Lower LVEF and smaller GLS in patients with normal LVEF are already recognized as risk factors for anthracycline-induced CTRCD. 11,14,15, 19 In the present study, LVEF was not an independent determinant for anthracyclineinduced CTRCD in the multivariable analysis, probably because GLS can detect myocardial injury more sensitively than LVEF. 45, 46 A history of ischemic heart disease is also considered a risk factor for CTRCD.…”

“…The present study is a subanalysis of a previous study in which we described the clinical features of anthracyclineinduced CTRCD. 19…”

Rituximab/bendamustine/cytarabine for transplant‐eligible patients with mantle cell lymphoma: A retrospective study

“…Only one patient developed Grade 3 or higher non‐hematological toxicity, which resulted in a reduction of the ejection fraction. We concluded that the cardiotoxicity was caused by R‐CHOP because it occurred prior to starting R‐BAC, and the doxorubicin contained in R‐CHOP is known to cause cardiotoxicity in a dose‐dependent manner 18,19 . One patient discontinued R‐BAC after two cycles due to a Grade 2 skin rash, which was diagnosed as eosinophilic pustulosis by a dermatologist.…”