Risk of Cardiac Heart Failure, Arrhythmia Increased With Anthracycline for Lymphoma

Lymphoma is often treated with anthracyclines. However, as lymphoma survival rates continue to rise so does the risk of developing anthracycline-induced cardiovascular disease (CVD). In a study presented at the 61st American Society of Hematology (ASH) Annual Meeting & Exposition, held in Orlando, Florida, researchers found anthracycline use to be associated with an increased risk of cardiac heart failure and arrhythmia.

The recent prospective study included 3063 patients with lymphoma who did not have cardiovascular disease prior to lymphoma diagnosis. The patients completed a risk factor questionnaire and were contacted every 6 months for the first 3 years after diagnosis to assess disease status; retreatment; and any onset of cardiovascular diseases, including congestive heart failure (CHF), coronary artery disease (CAD), valvular disease (VHD), and arrhythmia.

At a median follow-up of 6.9 years, there were 280 confirmed cases of cardiovascular disease post lymphoma, including 86 CHF, 78 CAD, 40 VHD, and 164 arrhythmia. At 5 and 10 years, the cumulative incidence of CVD was 6% and 10.7%. Anthracycline treatment, male sex, and increasing age, as well as some lifestyles choices including former smoker, current smoker, body mass index (BMI) more than 30 kg/m² were associated with increased risk of overall CVD.

After adjusting for cardiac risk factors, anthracycline was significantly associated with an increased risk of CHF and arrythmia, but not VHD or CAD. The number of anthracycline cycles was also significantly associated with an increased risk of CVD, with 0, 1 to 5, 6, and more than 6 anthracycline cycles associated with CVD incidences of 5%, 6.9%, 7.4%, and 7.7%, respectively. More specifically, the number of anthracycline cycles was also associated with significantly increased hazard ratios for CHF and arrhythmia.

“Both traditional CVD risk factors and treatment with anthracyclines was associated with an increased risk of developing CVD, and anthracyclines were a risk factor for arrhythmia and CHF in particular. Prevention of CVD in lymphoma patients will need to address both treatment and traditional lifestyle factors,” concluded the study authors.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Boddicker NJ, Maurer MJ, Larson MC, et al. Treatment and lifestyle risk factors for cardiovascular disease post lymphoma diagnosis: a prospective study in the modern treatment era. Oral presentation at: 61st ASH Annual Meeting & Exposition; December 7-10, 2019; Orlando, FL. Abstract 422.