title: Pre-existing arterial hypertension as a risk factor for early left ventricular systolic dysfunction following (R)-CHOP chemotherapy in patients with lymphoma.
abstract: Experimental studies in animals suggest that arterial hypertension may be a specific risk factor predisposing to anthracycline cardiotoxicity. The aim was determination of the effect of pre-existing arterial hypertension on the development of early left ventricular systolic dysfunction (LVSD) directly after rituximab, cyclophosphamide, doxorubicin, vincristin, prednisone ([R]-CHOP) chemotherapy in patients with lymphomas.The study included 208 patients with non-Hodgkin's lymphoma receiving conventional doxorubicin. LVSD was defined as a decrease of left ventricular ejection fraction below 50% and at least by 10 percentage points from baseline value. Patients with pre-existing hypertension more frequently developed new LVSD (19.7% vs. 6.6%; P = .004), pitting edema of the ankles (23.9% vs. 9.5%; P = .005), and nycturia (21.1% vs. 7.3%; P = .004) compared with patients without hypertension. As a consequence, the hypertension subgroup suffered from more delays of subsequent chemotherapy cycles (26.8% vs. 14.6%; P = .03), more reductions of doxorubicin doses (18.3% vs. 8.8%; P = .05), and premature discontinuations of chemotherapy (16.9% vs. 7.3%; P = .03). On logistic regression analyses, hypertension was one of the most important risk factors for developing new LVSD after (R)-CHOP chemotherapy.Arterial hypertension confers a significant risk of early LVSD in lymphoma patients treated with (R)-CHOP chemotherapy, interfering with its recommended schedule of administration.
authors.affiliation: Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, Otwock, Poland. Electronic address: s.szmit@gmail.com.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Szmit
authors.affiliation: Department of Hematology, Jagiellonian University, Krakow, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jurczak
authors.affiliation: Department of Propedeutic Oncology, Medical University of Gdansk and Gdynia Oncology Center, Gdynia, Poland.
authors.forename: Jan Maciej
authors.initials: JM
authors.lastname: Zaucha
authors.affiliation: Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Drozd-Sokołowska
authors.affiliation: Internal Medicine and Oncology Clinic, Silesian Medical University, Katowice, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Spychałowicz
authors.affiliation: Department of Hematology, University of Medical Sciences, Poznan, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Joks
authors.affiliation: Department of Hematology, Jagiellonian University, Krakow, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Długosz-Danecka
authors.affiliation: Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, Otwock, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001795:Blood Pressure Determination; D015331:Cohort Studies; D016001:Confidence Intervals; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D000069283:Rituximab; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; 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: Cardiac damage; doxorubicin; prevention