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

Abstract

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.

Late Cardiological Sequelae and Long-Term Monitoring in Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors: A Systematic Review by the Fondazione Italiana Linfomi

“…Of 13 included studies, 2 studies [ 7 , 8 ] were included in the Stone’s systematic review [ 33 ] and not evaluated separately. These studies were conducted from 1964 to 2018.…”

Assessment and management of newly diagnosed classical Hodgkin lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance

“…Treatment-induced cardiotoxicities are dose-related and include cardiomyopathies, coronary artery disease, arrhythmias, valvular and pericardial disease. 63,64 Bleomycin exposure 65 and thoracic RT are known causes of pulmonary toxicity. Risks for late lung fibrosis are dose-related and greater in patients with acute treatment-induced pneumonitis or pre-existing interstitial lung disease.…”

Cardiovascular Health during and after Cancer Therapy

“…In addition, radiation can increase atherosclerosis, leading to myocardial ischemia that can cause heart failure. This is a contributor to the elevated rates of cardiovascular disease seen in lymphoma survivors [ 4 , 5 ], including pericardial diseases, valvular diseases, and atherosclerotic disease (e.g., worse outcomes after percutaneous coronary intervention in Hodgkin’s Lymphoma survivors compared to the general population) [ 6 ]. Preventing radiation-induced heart disease is largely dependent on exposing the cardiac tissue to the lowest effective dose of radiation, as cardiotoxicity increases linearly with radiation dose (with no clear safe threshold) [ 7 ].…”