Increased Attention to Cardiovascular Events in DLBCL Warranted

TON - January 2017, Vol 10, No 1 - Conference Correspondent
Phoebe Starr

San Diego, CA—Patients with diffuse large B-cell lymphoma (DLBCL) are at increased risk for cardiovascular (CV) events, particularly during the first year following diagnosis, and these events shorten their lives, according to a retrospective study presented at the 2016 Annual Meeting of the American Society of Hematology. In a multivariate analysis, older age and body mass index (BMI) >30 were significant risk factors for developing CV events in patients with DLBCL.

“One in 10 patients with DLBCL is likely to develop a CV event in the first year after diagnosis. These findings suggest that it is important to identify patients at high risk, monitor them, and apply cardioprotective strategies in patients with a history of cardiovascular disease, and in older patients, as well as those with increased BMI,” said lead author Sabarish Ram Ayyappan, MBBS, University Hospitals, Case Medical Center, Cleveland, OH.

DLBCL is the most common type of non-Hodgkin lymphoma, and it occurs more frequently in elderly patients. Median age at diagnosis is 65 years, which is the same age at which CV events typically begin to occur. Anthracycline-based chemotherapy is the standard of care for DLBCL, but it carries a risk for cardiotoxicity.

The retrospective analysis was based on 413 patients with DLBCL treated at Case Medical Center between 2001 and 2014. Data collected on patient characteristics included CV risk factors, disease characteristics, baseline cardiac function, treatment details, and outcomes, including response, relapse, and CV events.

Median age at diagnosis was 63 years, 54% of patients were men, and 139 patients were older than 70 years. DLBCL was aggressive in 62% of patients. Median BMI was 27.9. At baseline, 59% had stage III or IV disease; 398 were treated with chemotherapy, and of these, 88% received anthracyclines. During treatment, 52% received 6 cycles of chemotherapy.

At a median follow-up of 33 months, 46% (n = 19) of patients relapsed and 34% (n = 140) died. The 3-year overall survival rate was 70%, and the 3-year progression-free survival rate was 58.8%.

After diagnosis, 18% (n = 74) of patients developed approximately 100 CV events: 43 patients developed congestive heart failure; 10, asymptomatic heart failure; 18, atrial fibrillation; 4, arrhythmia; 1, myocardial infarction; 12, coronary artery disease; 7, cerebrovascular accident; and 3, other. The 1-year cumulative incidence was 9.7%, and the 3-year cumulative incidence was 14.7%.

In a univariate analysis, age >60 years; previous history of congestive heart failure, coronary artery disease, arterial hypertension, chronic obstructive pulmonary disease, and chronic renal failure; and BMI >30 were significantly associated with CV events (P <.05).

In a multivariate analysis, only age >60 years and BMI >30 remained significant (P = .010 and P = .001, respectively). Patients who experienced a CV event in the first year after diagnosis had an estimated 3-year overall survival rate of 49% compared with 71.7% in patients who did not experience a CV event in the first year (P = .002). “The effect remained the same regardless of exposure to anthracyclines,” Dr Ayyappan stated.

Study limitations include that it was a retrospective analysis with a potential selection bias, no standardized follow-up for CV monitoring, and incomplete data on cause of death.

Related Items
MONALEESA-7 Sets New Standard of Care for Premenopausal Women with Advanced Breast Cancer
Phoebe Starr
TON - August 2019, Vol 12, No 4 published on August 6, 2019 in Breast Cancer
Studies Show ACA Reduces Disparities and Increases Access to Earlier Diagnosis and Treatment
Phoebe Starr
TON - August 2019, Vol 12, No 4 published on August 6, 2019 in ASCO
FDA Unveils Pilot Program to Expand Access to Investigational Oncology Drugs
Phoebe Starr
TOP - August 2019, Vol 12, No 3 published on July 29, 2019 in ASCO
Studies Show ACA Reduces Disparities and Increases Access to Earlier Diagnosis and Treatment
Phoebe Starr
TOP - August 2019, Vol 12, No 3 published on July 29, 2019 in ASCO
Reduced-Intensity Chemotherapy for Frail Elderly Patients with Advanced Gastroesophageal Cancer
Phoebe Starr
TOP - August 2019, Vol 12, No 3 published on July 29, 2019 in Geriatric Cancer
Enzalutamide or Apalutamide Added to ADT Are 2 New Options for Hormone-Sensitive Prostate Cancer
Phoebe Starr
TOP - August 2019, Vol 12, No 3 published on July 29, 2019 in Prostate Cancer
Practice-Changing Results: Olaparib Maintenance Therapy Extends Progression-Free Survival in Metastatic Pancreatic Cancer with BRCA Mutations
Phoebe Starr
TOP - August 2019, Vol 12, No 3 published on July 29, 2019 in Pancreatic Cancer
T-DM1 Reduces Residual Invasive Disease in Patients with HER2-Positive Breast Cancer After Chemotherapy
Phoebe Starr
TOP - May 2019, Vol 12, No 2 published on May 13, 2019 in Breast Cancer
Atezolizumab plus Nab-Paclitaxel for Triple-Negative Breast Cancer with PD-L1 Expression
Phoebe Starr
TOP - May 2019, Vol 12, No 2 published on May 13, 2019 in Breast Cancer
First-Line Pembrolizumab plus Axitinib Combination Boosts Survival in Metastatic Renal-Cell Carcinoma
Phoebe Starr
TOP - May 2019, Vol 12, No 2 published on May 13, 2019 in Renal-Cell Carcinoma
Last modified: February 2, 2017