title: The effects of cardiovascular disease on the clinical outcome of elderly patients with diffuse large B-cell lymphoma.
abstract: We identified 3910 elderly (>65 yrs) patients with diffuse large B-cell lymphoma (DLBCL) who received doxorubicin-based (+/-rituximab) therapy and 77 347 cancer-free controls, and assessed cardiovascular events and survival in relation to preexisting cardiovascular comorbidities. Compared to controls, patients with DLBCL had a 3.4-fold (95%CI 3.0-3.9) and 2.5-fold (95%CI 2.3-2.7) increased risk of congestive heart failure (CHF)/cardiomyopathy (CM) within 6 months and 3 years of diagnosis, respectively. Risk of acute myocardial infarction (AMI) was similarly increased. The risk of CHF/CM and AMI was significantly higher in those patients with DLBCL (vs. controls) who did not report preexisting cardiovascular disease, compared to those who had preexisting cardiovascular disease; this was due to dose reductions of doxorubicin among patients with preexisting cardiovascular disease. Rituximab improved survival in patients with stage III-IV (but not I-II) disease (p-interaction = 0.0003). Our novel findings emphasize the need to reduce cardiac toxicity of doxorubicin in elderly DLBCL patients.
authors.affiliation: Biostatistics Branch, Division of Cancer Epidemiology and Genetics.
authors.forename: Huei-Ting
authors.initials: HT
authors.lastname: Tsai
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: Joan
authors.initials: J
authors.lastname: Warren
authors.forename: Wyndham
authors.initials: W
authors.lastname: Wilson
authors.forename: Ola
authors.initials: O
authors.lastname: Landgren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000401:mortality; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D000069283:Rituximab / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000069283:Rituximab; D004317:Doxorubicin
keywords: Cardiovascular disease; doxorubicin; elderly cardiac failure; outcome; prognosis; rituximab; survival