eJHaem (Nov 2020)

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

  • Takafumi Nakayama,
  • Yoshiko Oshima,
  • Shigeru Kusumoto,
  • Junki Yamamoto,
  • Satoshi Osaga,
  • Haruna Fujinami,
  • Takaki Kikuchi,
  • Tomotaka Suzuki,
  • Haruhito Totani,
  • Shiori Kinoshita,
  • Tomoko Narita,
  • Asahi Ito,
  • Masaki Ri,
  • Hirokazu Komatsu,
  • Kazuaki Wakami,
  • Toshihiko Goto,
  • Tomonori Sugiura,
  • Yoshihiro Seo,
  • Nobuyuki Ohte,
  • Shinsuke Iida

DOI
https://doi.org/10.1002/jha2.110
Journal volume & issue
Vol. 1, no. 2
pp. 498 – 506

Abstract

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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.

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