Long‐term risk of cardiovascular mortality in lymphoma survivors: A systematic review and meta‐analysis

Boyne, Devon J.; Mickle, A.; Brenner, Darren R.; Friedenreich, Christine M.; Cheung, Winson Y.; Tang, Karen; Wilson, Todd; Lorenzetti, Diane; James, Matthew T.; Ronksley, Paul E.; Rabi, Doreen M.

doi:10.1002/cam4.1572

Cited by 43 publications

(29 citation statements)

References 83 publications

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“…Hence, these conditions share many risk factors. ED precedes CVD by 2-5 years [16], and we believe this is of special importance as auto-SCT lymphoma survivors are at increased risk of fatal CVD [1,38].…”

Section: Discussionmentioning

confidence: 99%

Sexual function in long-term male lymphoma survivors after high-dose therapy with autologous stem-cell transplantation

Bersvendsen

Haugnes

Dahl

et al. 2019

Bone Marrow Transplant

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Reduced sexual function may have negative implications on health related quality of life among lymphoma survivors. A national cross-sectional study among long-term lymphoma survivors after high-dose therapy with autologous stem-cell transplantation auto-SCT treated during 1987-2008 was conducted in 2012-2014. The current study explored sexual functioning among these survivors. Sixty-six percent (n=159) of eligible men with complete questionnaire data were included, median age was 55 years. The Brief Sexual Function Inventory (BSFI) was used to assess sexual function and sexual satisfaction, compared with age-matched controls. In addition, sexual problems were defined based on predetermined cutoff values for BSFI domain scores. Sexual drive and erections firm enough to have sexual intercourse were reported to be present only a few days or less last month among 30% and 41% of survivors, respectively. Sexual satisfaction was reported by 39% of survivors. The survivors had significantly lower scores on all BSFI domains and an increased risk of problems with sexual drive and erection compared with controls. In multivariable models, cardiovascular disease was significantly associated with worse erectile function, while age >55 years, chronic fatigue, and physical inactivity were significantly associated with lower sexual functioning overall. Chronic fatigue and anxiety were related to lower sexual satisfaction.

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Section: Discussionmentioning

confidence: 99%

Sexual function in long-term male lymphoma survivors after high-dose therapy with autologous stem-cell transplantation

Bersvendsen

Haugnes

Dahl

et al. 2019

Bone Marrow Transplant

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“…Lymphoma survivors have an increased risk of fatal cardiovascular events compared to general populations [25]. The pooled number of deaths due to cardiovascular disease-with respect to different confounders as gender, age at treatment and comorbidities-was estimated to be 7.31 and 5.35 times that of normal population for Hodgkin and non-Hodgkin lymphoma survivors, respectively [25]. For mediastinal Hodgkin´s lymphoma Paumier, et al were the first to describe a significant dose reduction of 15% to 20% to the coronary arteries, heart and the lungs by DIBH compared with FB.…”

Section: Resultsmentioning

confidence: 99%

DIBH-VMAT for Consolidation RT in Mediastinal B-NHL can Significantly Reduce Doses to OAR Report of Two Cases

Fahrig¹,

Koch²,

Heine³

et al. 2019

Int J Radiol Imaging Technol

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has shown to improve significantly both overall survival (OS) and progression-free survival (PFS) even in the rituximab era significantly and also in patients with nonbulky-disease [1-3]. The advances with chemotherapy and radiotherapy have considerably increased the survival rates. Most of the patients are in a middle age of 50 to 60 years and the treatment is in principle curative with a five year PFS of 75-90%. Therefore on the one hand, DLBCL has to be adequately treated to reach a curative outcome, on the other hand RT-delivery should avoid critical dose burden to organs at risk, i.e. especially the heart and the lungs, in order to reduce late cardiac morbidity and the risk for secondary lung cancer. In Hodgkin´s disease, the relative risk (RR) of secondary lung cancer increases considerably in relation to the dose of ionizing radiation, with a RR of 9.6 when more than 9 Gy are administered [4]. Less is known about the correlation between NHL and second lung cancer. Although, the RR is higher in long-term NHL survivors than in healthy individuals. The risk for cardiac mortality and secondary cancers can be estimated using calculation models. Toltz, et al. used the relative seriality model to predict excess risk of cardiac mortality and a modified linear quadratic model to predict the Excess Absolute Risk (EAR) for induction of lung cancer and breast cancer in patients with Hodgkin´s Lymphoma, NHL or breast cancer [5]. They compared the results of 3D conformal photon radiotherapy (3D-CRT) and intensity modulated proton therapy (IMPT). The excess risk of cardiac mor-Abstract Background: Consolidative radiotherapy after immunochemotherapy in localized bulky diffuse large B-cell lymphoma (DLBCL) patients significantly improves both, overall and progression-free survival and treatment is in principle curative. Therefore protection of organs at risk is highly relevant. Case, planning and results: Two 53-years and 18-years old patients with bulky mediastinal DLBCL were planned with and without deep inspiration breath-hold (DIBH) and volumetric modulated arc therapy (VMAT). DIBH reduced the doses to the heart and the lungs while homogeneity and conformity were not compromised. The number of Monitor Units (MU) needed was significantly reduced by DIBH-VMAT. Both patients were treated in DIBH-VMAT. Conclusion: Planning with DIBH in bulky mediastinal DLBCL is feasible and should be taken into account due to the high relevance with regard to acute and late toxicity.

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“…This systematic review and meta‐analysis suggests that, compared with the general population, lymphoma survivors are at an elevated risk of developing cardiovascular events. Together with the meta‐analysis that we previously completed, in which we investigated cardiovascular mortality in lymphoma survivors, it is apparent that both HL and NHL survivors have both a higher incidence and severity of cardiovascular events compared with the general population. Though there were high levels of unexplained heterogeneity present, a novel finding in our meta‐analysis is the differences in observed magnitude of increased risk between the various CVD subtypes, notably, the 10‐fold and 13‐fold increases in risk for PD and VHD, respectively, in HL.…”

Section: Discussionmentioning

confidence: 99%

“…There were no restrictions applied by geographical location, date, or language. Keywords, along with medical subject headings, were included in the search and have been previously published . Observational study design filters were adapted using keywords and subject headings from two previously designed search strategies .…”

Section: Methodsmentioning

confidence: 99%

“…The long‐term cardio‐toxic effects of these treatments, especially chemotherapy regimens utilizing anthracyclines and radiation therapy, have become more apparent in cancer survivors over the past decade . We previously conducted a meta‐analysis and found that the number of deaths due to CVDs within HL and NHL survivors were 7.31 (95% CI, 5.29‐10.10) and 5.35 (95% CI, 2.55‐11.24) times greater than the general population, respectively . In acknowledging that there is a substantially increased risk of mortality because of cardiovascular‐related events, we sought to further investigate if there is also an increased risk of CVD incidence within this population.…”

Section: Introductionmentioning

confidence: 99%

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Treatment for lymphoma and late cardiovascular disease risk: A systematic review and meta‐analysis

Stone

Mickle

Boyne

et al. 2019

Health Science Reports

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Background and aimsLymphoma patients are frequently treated with cancer therapies that may increase the risk of adverse health outcomes later in life, including cardiovascular disease (CVD) mortality. We sought to investigate the long‐term risk of CVD incidence in this survivor population relative to the general population to quantify this health burden.MethodsA systematic review and meta‐analysis was conducted using EMBASE, MEDLINE, and CINAHL databases, from date of inception to November 2016, with additional searches completed through June 2018. Included reports were observational studies assessing CVD incidence in patients of either Hodgkin or non‐Hodgkin lymphoma (HL, NHL) who survived for at least 5 years from the time of diagnosis or if the study had a median follow‐up of 10 years. Meta‐analyses were performed using random effects models, and subgroup analyses were conducted to determine the incidence of specific CVD subtypes (coronary heart disease, pericardial disease, valvular heart disease, myocardial disease, cardiac dysrhythmia, and cerebrovascular disease). Heterogeneity was assessed using I 2 statistics and prediction intervals.ResultsOf the 7734 studies identified, 22 studies were included in this review, representing 32 438 HL and NHL survivors. Relative to the general population, lymphoma survivors had statistically significant two to threefold increases in the risk for nearly all subtypes of CVD examined. Lymphoma survivors appeared to be particularly susceptible to pericardial diseases (HL: 10.67, 95% confidence interval (CI), 7.75‐14.69; NHL: 4.70, 95% CI, 2.08‐10.61) and valvular diseases (HL: 13.10, 95% CI, 7.41‐23.16; NHL: 3.76, 95% CI, 2.12‐6.66). Although the 95% CIs were suggestive of increased risks, the 95% prediction intervals often included the null, reflecting the high heterogeneity of the estimates.ConclusionGiven the suggested increased risks of cardiovascular outcomes in lymphoma survivor populations relative to the general population, tailored screening and prevention programmes may be warranted to offset the future burden of disease.

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Long‐term risk of cardiovascular mortality in lymphoma survivors: A systematic review and meta‐analysis

Cited by 43 publications

References 83 publications

Sexual function in long-term male lymphoma survivors after high-dose therapy with autologous stem-cell transplantation

Sexual function in long-term male lymphoma survivors after high-dose therapy with autologous stem-cell transplantation

DIBH-VMAT for Consolidation RT in Mediastinal B-NHL can Significantly Reduce Doses to OAR Report of Two Cases

Treatment for lymphoma and late cardiovascular disease risk: A systematic review and meta‐analysis

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