title: Premature cardiovascular mortality in lymphoma patients treated with (R)-CHOP regimen - a national multicenter study.
abstract: BACKGROUND
  Premature cardiovascular mortality related to chemotherapy and occurred in lymphoma survivors before disease progression is one of significant clinical failure of modern hematology. The aim of this retrospective analysis was to evaluate early cardiovascular mortality and its predictors in patients treated with the (R)-CHOP regimen.
  
  
  METHODS
  The study assessed 610 patients: 581 patients were treated with non-liposomal doxorubicin (cumulative dose of 337 ± 96 mg/m2), and 29 patients with liposomal non-pegylated doxorubicin (cumulative dose of 237 ± 126 mg/m2). Their present status, history of cardiovascular diseases and associated risk factors were recorded.
  
  
  RESULTS
  The analysis identified 93 deaths (15.5%): 51 cases (55%) related to lymphoma disease progression and 28 (30%) to cardiovascular complications. Multivariate Cox analysis revealed history of previous heart diseases (HR=4.71; CI: 3.82-5.6; p<0.001), ECG rhythm abnormalities related to chemotherapy (HR=4,78; CI: 3.63-5.92; p=0,01), and lack of complete remission (HR=2.73; CI: 1.78-3.66; p=0.03), as the independent predictors for cardiovascular death. Neither decreased LVEF nor increasing cumulative dose of anthracyclines had a significant predictive value for cardiovascular prognosis.
  
  
  CONCLUSIONS
  The study indicated that cardiovascular mortality in lymphoma patients treated with (R)-CHOP regimen is relatively high and ECG monitoring may be the most effective in cardiological risk assessment. The unfavorable outcome depended on lack of complete remission that seems to be a consequence of patients' individual susceptibility for cardiac events, which should become a purpose of further trials.
authors.affiliation: Department of Hematology, Jagiellonian University, Krakow, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jurczak
authors.forename: Sebastian
authors.initials: S
authors.lastname: Szmit
authors.forename: Marcin
authors.initials: M
authors.lastname: Sobociński
authors.forename: Maciej
authors.initials: M
authors.lastname: Machaczka
authors.forename: Joanna
authors.initials: J
authors.lastname: Drozd-Sokołowska
authors.forename: Monika
authors.initials: M
authors.lastname: Joks
authors.forename: Justyna
authors.initials: J
authors.lastname: Dzietczenia
authors.forename: Tomasz
authors.initials: T
authors.lastname: Wróbel
authors.forename: Beata
authors.initials: B
authors.lastname: Kumiega
authors.forename: Jan Maciej
authors.initials: JM
authors.lastname: Zaucha
authors.forename: Wanda
authors.initials: W
authors.lastname: Knopińska-Posłuszny
authors.forename: Wojciech
authors.initials: W
authors.lastname: Spychałowicz
authors.forename: Anna
authors.initials: A
authors.lastname: Prochwicz
authors.forename: Anna
authors.initials: A
authors.lastname: Drohomirecka
authors.forename: Aleksander B
authors.initials: AB
authors.lastname: Skotnicki
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D016903:Drug Monitoring / Q000379:methods; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000139:chemically induced* / Q000401:mortality*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Cardiotoxicity; Cardiovascular death; Doxorubicin; Lymphoma; Prognosis