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. 2015 Oct 6;5(10):e008350.
doi: 10.1136/bmjopen-2015-008350.

Pattern of Cardiac Surveillance Among Patients With Lymphoma Receiving Anthracycline-Based Chemotherapy

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Free PMC article

Pattern of Cardiac Surveillance Among Patients With Lymphoma Receiving Anthracycline-Based Chemotherapy

Olivia Y Hung et al. BMJ Open. .
Free PMC article

Abstract

Objective: Anthracyclines are potent antineoplastic agents in the treatment of lymphoid malignancies, but their therapeutic benefit is limited by cardiotoxicity. The American Heart Association (AHA) recommends routine surveillance, early diagnosis and treatment of anthracycline-based chemotherapy (AC) induced cardiomyopathy (AC-CMP). We aimed to assess the prevalence of AC-CMP in patients with lymphoma, surveillance patterns of left ventricular ejection fraction (LVEF) in those receiving AC and management of patients with AC-CMP at an academic medical centre prior to the development of a comprehensive cardio-oncology programme.

Methods: We performed a retrospective cohort study examining 218 patients with aggressive B cell non-Hodgkin's lymphomas (B-NHL) who received AC 1992-2012 and had serial follow-up. AC-CMP was defined as LVEF decrease ≥10% with final LVEF≤50% or LVEF reduction ≥15% regardless of final LVEF.

Results: Of 218 patients treated with AC, 73 (34%) had LVEF assessment both prior to and after receiving AC. Of these 73 patients, 24 developed AC-CMP and had higher cumulative all-cause mortality than those without AC-CMP (HR 2.35, p=0.03). Coronary artery disease (CAD) was an independent predictor of AC-CMP (p=0.048). Mean post-AC LVEF was lower in patients with CAD compared with those without CAD when their baseline LVEF was 45% (p=0.0009) or 55% (p=0.001) but was similar at 65% (p=0.33). Less than half of patients with AC-CMP received recommended heart failure medication therapy.

Conclusions: Historically, one-third of patients with B-NHL treated with AC underwent surveillance according to AHA guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of patients with lymphoma receiving AC.

Figures

Figure 1
Figure 1
Surveillance pattern among patients with aggressive non-Hodgkin's lymphoma who received anthracycline-based chemotherapy. Imaging surveillance of LVEF was performed with either transthoracic echocardiogram or multigated acquisition scan (AC, anthracycline-based chemotherapy; AC-CMP, anthracycline-based chemotherapy-induced cardiomyopathy; B-NHL, B cell non-Hodgkin's lymphoma; LVEF, left ventricular ejection fraction).
Figure 2
Figure 2
Cumulative survival among 73 patients with lymphoma with left ventricular ejection fraction assessment before and after receiving anthracycline-based chemotherapy by the presence or absence of anthracycline-based chemotherapy-induced cardiomyopathy (CMP). Cumulative survival by presence or absence of CMP. The median years on study for survivors were 2.99 years.
Figure 3
Figure 3
Venn diagram of patients with anthracycline-based chemotherapy-induced cardiomyopathy (AC-CMP) who received medication therapy and additional left ventricular ejection fraction (LVEF) surveillance. Thirteen of 24 patients with AC-CMP received medication therapy or underwent additional LVEF evaluation. Four patients only had additional LVEF evaluation and two patients were treated only with ACE inhibitors. Three patients received both ACE inhibitor and β-blocker medications while one patient received β-blocker therapy with repeat LVEF assessment. Three patients were treated with both ACE inhibitors and β-blockers and underwent additional LVEF evaluation.

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