Yazarlar : Tsai H, Pfeiffer R, Warren J et al

Yayın : Leuk Lymphoma

Yayın Yılı : 2014

Pubmed Linki : http://www.docguide.com/effects-cardiovascular-disease-clinical-outcome-elderly-patients-diffuse-large-b-cell-lymphoma?tsid=5

Konu : Geriyatrik Hematoloji

Literatür İçeriği :  ABSTRACT In diffuse large B-cell lymphoma (DLBCL) patients, doxorubicin-related cardiotoxicity is a common clinical problem that increases with cumulative dose. We identified 3,910 DLBCL elderly patients (age 66 years or older) diagnosed 2000 to 2005 who received doxorubicin-based therapy through 2006, and 77,347 cancer-free controls and determined preexisting cardiovascular co-morbidities. Using Cox proportional hazards models we compared risk of cardiovascular outcomes between cases and controls. We also assessed the impact of doxorubicin and rituximab on the risk of cardiovascular events and overall survival. Compared to controls, DLBCL patients had an increased risk of congestive heart failure (CHF)/cardiomyopathy (CM) within six-months (hazard ratio[HR]=3.42: 95% confidence interval[CI]: 3.02-3.86) and three years of diagnosis (HR=2.45: 2.26-2.67); risk of acute myocardial infarction (AMI) risk was similarly increased. The risk of CHF/CM and AMI was statistically significantly higher in those DLBCL patients (vs. controls) who did not report preexisting cardiovascular disease, compared to those who had preexisting cardiovascular disease. This was due to dose reductions of doxorubicin among patients with preexisting cardiovascular disease. Rituximab use did not significantly alter risk of CHF/CM or AMI. Patients with stage III-IV (vs. I-II) and presence (vs. absence) of preexisting cardiovascular disease had a significantly higher risk of dying. Rituximab improved survival in patients with stage III-IV (but not I-II) disease (p-interaction=0.0003). Our novel findings on treatment related cardiac events in elderly patients with DLBCL emphasize the need to reduce the cardiac toxicity of doxorubicin.

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