Primary Cardioprotection Reduces Mortality in Lymphoma Patients with Increased Risk of Anthracycline Cardiotoxicity, Treated by R-CHOP Regimen

Monika Długosz-Danecka, Alicja M. Gruszka, Sebastian Szmit, Agnieszka Olszanecka, Tomasz Ogórka, Marcin Sobociński, Andrzej Jaroszyński, Katarzyna Krawczyk, Aleksander B. Skotnicki, Wojciech Jurczak

Research output: Contribution to journalArticle

Abstract

Background: Advances in anti-lymphoma therapy prolong overall survival, making late adverse effects, like doxorubicin-related cardiotoxicity, an even more important clinical issue. The effectiveness of cardioprotective strategies with close monitoring, angiotensin-converting enzyme inhibitors and/or β-blockers as well as liposomal doxorubicin are still unconfirmed in clinical practice. Methods: This study evaluated the role of a primary cardioprotection strategy in preventing cardiovascular mortality and heart failure occurrence in non-Hodgkin lymphoma (NHL) patients with a high risk of anthracycline cardiotoxicity. Thirty-five NHL patients were subjected prospectively to ramipril and/or bisoprolol at NHL diagnosis, before implementing doxorubicin-containing regimens. Additionally, patients with a diagnosis of asymptomatic/mild heart failure received the liposomal form of doxorubicin. The clinical outcome and frequency of all serious cardiac events were compared with the results in a historical cohort of 62 high-risk cases treated without primary cardioprotection. Results: NHL patients with a primary cardioprotection strategy did not experience cardiovascular deaths in contrast to the retrospective control group where cardiovascular mortality was 14.5% at 3 years (p < 0.05). Primary cardioprotection also decreased the frequency of new cardiotoxicity-related clinical symptoms (2.8 vs. 24.1%; p < 0.05) and prevented the occurrence of cardiac systolic dysfunction (0 vs. 8.5%, respectively; p < 0.05). Although the study was not planned to detect any survival benefit, it demonstrated a trend towards increased response rates (complete response 82 vs. 67%; p not significant) and prolonged survival (projected 5-year overall survival 74 vs. 60%; p < 0.05) for patients treated with primary cardioprotection. Conclusions: A primary personalized cardioprotection strategy decreases the number of cardiac deaths and may potentially prolong overall survival in NHL patients with increased risk of anthracycline cardiotoxicity.

Original languageEnglish
Pages (from-to)238-245
Number of pages8
JournalChemotherapy
Volume63
Issue number4
DOIs
Publication statusPublished - Nov 1 2018

Keywords

  • Cardio-oncology
  • Cardioprotection
  • Cardiotoxicity
  • Doxorubicin
  • Lymphoma

ASJC Scopus subject areas

  • Oncology
  • Pharmacology
  • Drug Discovery
  • Pharmacology (medical)
  • Infectious Diseases

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  • Cite this

    Długosz-Danecka, M., Gruszka, A. M., Szmit, S., Olszanecka, A., Ogórka, T., Sobociński, M., Jaroszyński, A., Krawczyk, K., Skotnicki, A. B., & Jurczak, W. (2018). Primary Cardioprotection Reduces Mortality in Lymphoma Patients with Increased Risk of Anthracycline Cardiotoxicity, Treated by R-CHOP Regimen. Chemotherapy, 63(4), 238-245. https://doi.org/10.1159/000492942