Increased risk of osteoporosis following commonly used first-line treatments for lymphoma: a Danish Nationwide Cohort Study

Bæch, John; Hansen, S.; Jakobsen, Lasse Hjort; Øvlisen, Andreas Kiesbye; Severinsen, Marianne Tang; Brown, Peter de Nully; Vestergaard, Peter; Frederiksen, Henrik; Jørgensen, Judit; Starklint, Jørn; Josefsson, Pär; Hammer, T.; Clausen, Michael Roost; Torp‐Pedersen, Christian; Jensen, Paw; El‐Galaly, Tarec Christoffer

doi:10.1080/10428194.2020.1723015

Cited by 22 publications

(36 citation statements)

References 25 publications

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“…Our results are, to some extent, in agreement with other studies on osteoporosis and fractures in patients with hematologic malignancies and specifically lymphoma (132)(133)(134)179). Most of the studies published on osteoporosis or fractures in lymphoma patients hitherto have been small.…”

Section: Patients With Lymphomasupporting

confidence: 92%

“…Two recent large studies have addressed the risk for osteoporosis and fractures in lymphoma patients. A Danish case-control study showed a 61% increased risk for osteoporotic events (osteoporosis treatment or low-energy fracture) in patients with DLBCL or FL treated with a R-CHOP-like therapy compared with controls from the Danish population (132). A retrospectively collected UK study on patients ≥70 years treated with R-CHOP, showed a cumulative fracture incidence of 11.4% 18 months after treatment with R-CHOP (133).…”

Section: Lymphoma and Bonementioning

confidence: 99%

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Increased Risk of Hip Fracture in Patients with Lymphoma, a Swedish Population Study of 37,236 Lymphoma Patients

et al. 2020

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Section: Patients With Lymphomasupporting

confidence: 92%

Section: Lymphoma and Bonementioning

confidence: 99%

Increased Risk of Hip Fracture in Patients with Lymphoma, a Swedish Population Study of 37,236 Lymphoma Patients

et al. 2020

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“…6 Recent Danish population-based data have been reported in 2589 patients receiving high-dose steroids for DLBCL or follicular lymphoma diagnosed between 2000 and 2012; a composite end point of "osteoporotic events" (osteoporosis treatment or lowimpact fracture) was found to be increased compared with an age and sex-matched population (n 5 12 945) (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.40-1.84). 7 The 5-and 10-year cumulative risks of osteoporotic events for patients with lymphoma were 10.0% and 16.3%, compared with matched population rates of 6.8% and 13.5%, respectively. Patients without an osteoporotic event within the first 2 years' posttreatment were not at higher risk of osteoporotic events in subsequent years.…”

Section: Introductionmentioning

confidence: 91%

Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma

et al. 2020

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Diffuse large B-cell lymphoma (DLBCL) and osteoporotic fracture are both more common in older patients. Exposure to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is likely to increase the risk of fracture, but evidence is lacking to define fracture incidence in this group. Data on consecutive patients with DLBCL aged ≥70 years treated with 1 to 8 cycles of full or attenuated R-CHOP were retrospectively collected across 10 UK centers (2009-2019). Patients were followed up from starting R-CHOP for a minimum of 6 months and censored at 18 months; at last follow-up if <18 months; or at progression or death. Of 877 patients identified, 148 were excluded: 121 had progression or died before 6 months; 23 had follow-up <6 months. Across 729 remaining patients, the median age was 77 years, and 68% had an Eastern Cooperative Oncology Group performance status of 0 to 1. Eighty-one fractures occurred within 18 months of follow-up; 42 were symptomatic, including 30 requiring hospital attendance or admission. The cumulative fracture incidence was 6.2% (95% confidence interval [CI], 4.7-8.2) at 6 months; 9.7% (95% CI, 7.8-12.1) at 12 months; and 11.4% (95% CI, 9.3-14.0) at 18 months. Multivariate analysis identified a predisposing history (osteoporosis, osteopenia, prior fracture, and rheumatoid arthritis [RhA]), DLBCL bone involvement at baseline, and receipt of prephase steroids as independent risk factors for fracture. There is a clinically relevant fracture risk and significant associated morbidity in older patients receiving R-CHOP. Careful attention to bone health is warranted in older patients receiving R-CHOP. Randomized studies are required to better define the most effective strategies to reduce fracture risk.

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“…Vertebral fractures are highly predictive of further fracture but reporting of these is poor in the UK [ 66 ] and there are a number of reasons why this may be even lower in an oncology setting [ 67 ]. The risk of poor bone health and fracture is increasingly recognised across a number of malignancies; for example, a recent large Danish registry study showed increased risk of fragility fracture in adults with haematological malignancy, with the largest risk in the first 2–4 years following initiation of treatment [ 68 ]. Given the devastating nature of fractures, there is much supportive care work to be done to identify and treat at risk patients and manage fragility fractures effectively across the spectrum of the cancer journey.…”

Section: Interface With Other Specialities (Eg Endocrinology and DImentioning

confidence: 99%

Supportive Care: An Indispensable Component of Modern Oncology

et al. 2020

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The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as ‘the prevention and management of the adverse effects of cancer and its treatment’. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.

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Increased risk of osteoporosis following commonly used first-line treatments for lymphoma: a Danish Nationwide Cohort Study

Cited by 22 publications

References 25 publications

Increased Risk of Hip Fracture in Patients with Lymphoma, a Swedish Population Study of 37,236 Lymphoma Patients

Increased Risk of Hip Fracture in Patients with Lymphoma, a Swedish Population Study of 37,236 Lymphoma Patients

Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma

Supportive Care: An Indispensable Component of Modern Oncology

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