Risk of Cardiotoxicity With Doxorubicin for DLBCL Does Not Include Ischemic Heart Disease, Stroke

Doxorubicin-containing treatment for diffuse large B-cell lymphoma (DLBCL) was not associated with increased risk for developing ischemic heart disease (IHD) or stroke, according to results of a study published in Leukemia & Lymphoma.

DLBCL is primarily a disease of the elderly. Up to two-thirds of patients who receive doxorubicin-containing treatment are cured; however, toxicity, particularly cardiac toxicity, remains a concern given the age of the patient population.

For this study, data from 1009 patients aged 75 years and older with DLBCL between 2003 and 2012 were extracted from Danish national databases. Patients were stratified by treatment and age- and sex-matched at a ratio of 10 persons from the general Danish population per 1 patient, for a control cohort of 10,090. Cardiovascular outcomes were evaluated.

The patient and control cohorts were 51.1% and 51.1% women and 85.3% and 70.6% were deceased as of the end of 2018, respectively (P <.0001). Patients received standard treatment with doxorubicin-containing regimens (651) or less intensive or palliative treatment (358).

During a median follow-up of 9.5 years, 14.2% of DLBCL survivors developed cardiovascular disease.

Standard treatment was associated with increased risk for venous thromboembolism (VTE; hazard ratio [HR], 2.1; 95% CI, 1.5-2.9) and decreased risk for IHD (HR, 0.5; 95% CI, 0.3-0.7). No associations were observed for heart failure (HR, 1.2; 95% CI, 0.9-1.6), stroke (HR, 0.9; 95% CI, 0.6-1.1), or atrial fibrillation (HR, 1.1; 95% CI, 0.9-1.4).

Patients who received standard treatment had an increased mortality risk compared with their counterparts in the control cohort (HR, 2.1; 95% CI, 1.9-2.3). Those who received less intensive/palliative treatment had an even greater mortality risk compared with their counterparts in the control cohort (HR, 3.6; 95% CI, 3.2-4.1).

The major limitation of this study was that patients did not undergo regular cardiovascular check-ups. Some events may have been underestimated.

This study found that doxorubicin-containing treatment for DLBCL was associated with increased risk for VTE events but not for IHD or stroke.

Reference

Juul MB, Jelicic J, Anru PL, et al. Cardiovascular diseases in elderly survivors of diffuse large B-cell lymphoma: a Danish population-based cohort study. Leuk Lymphoma. Published online April 18, 2022. doi:10.1080/10428194.2022.2064982