title: Nonpegylated Liposomal Doxorubicin as a Component of R-CHOP Is an Effective and Safe Alternative to Conventional Doxorubicin in the Treatment of Patients With Diffuse Large B-Cell Lymphoma and Preexisting Cardiac Diseases.
abstract: BACKGROUND
  The aim of this retrospective analysis was to investigate the efficacy and safety of nonpegylated liposomal doxorubicin (NPLD) as part of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) in patients with diffuse large B-cell lymphoma (DLBCL) and preexisting cardiac diseases.
  
  
  METHODS
  Twenty-five patients were evaluated, median age was 73 (range 24-85) years, 23 patients received NPLD as part of their first-line therapy. Most patients suffered from more than 1 cardiac disease and in 14 patients left ventricular ejection fraction (LVEF) was reduced. One hundred nineteen cycles of NPLD were applied with a median of 5 (range 2-8) cycles per patient. Median dose per cycle was 95 mg (50 mg/m(2)).
  
  
  RESULTS
  The overall response rate was 96% (44% complete remission, 52% partial remission). After a median follow-up of 23 months, 4 patients had disease relapse. Seven patients died, translating to an estimated 3-year progression-free and overall survival of 66% and 73%, respectively. Reasons for death were progressive disease or infection in 2 patients each and cardiovascular disease in 3 patients. After chemotherapy, LVEF decreased significantly in 28% and improved in 12% of patients, whereas median LVEF did not change (51% vs. 50%). No higher frequencies of decreased LVEF was observed in the group of patients with preexisting reduced LVEF. Five adverse events induced therapy termination: 2 myocardial infarctions, 2 pneumonias, and 1 reduced condition. No hand-foot-syndrome was observed.
  
  
  CONCLUSIONS
  NPLD as a component of R-CHOP is an effective treatment in patients with DLBCL and preexisting cardiac diseases, whereas cardiac events were observed in 36% of patients in this cardiac high-risk group. However, these results need to be confirmed in a prospective randomized trial.
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany. Electronic address: sarah.rohlfing@med.uni-heidelberg.de.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rohlfing
authors.affiliation: Department of Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Aurich
authors.affiliation: Pharmacy, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Schöning
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Witzens-Harig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006331:Heart Diseases / Q000188:drug therapy*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Cardiac toxicity; DLBCL; Elderly; Liposomal doxorubicin; Reduced LVEF