title: Acute decompensated heart failure as a reason of premature chemotherapy discontinuation may be independent of a lifetime doxorubicin dose in lymphoma patients with cardiovascular disorders.
abstract: BACKGROUND
  Algorithm of anthracycline-based chemotherapy with favourable cardio-oncological outcome should be clearly re-defined for lymphoma patients with significant pre-existing cardiovascular diseases. A clinical benefit of liposomal forms of anthracycline is still debatable.
  
  
  METHODS
  Polish registry included observations of 138 lymphoma patients with concomitant cardiovascular disorders who received liposomal doxorubicin as cardioprotective alternative of conventional form. It was created to analyse the importance of a strategy of administration of conventional/liposomal doxorubicin and a lifetime doxorubicin dose for development of acute decompensated heart failure (ADHF) as a reason of premature chemotherapy discontinuation.
  
  
  RESULTS
  ADHF was the cause of premature termination of chemotherapy only in 11 patients (7.97%). The five new episodes of ADHF related to liposomal doxorubicin were recorded in subgroup of 70 patients with pre-existing heart failure (7.14%). There was the similar incidence of ADHF when liposomal doxorubicin was applied after conventional form in dose 200mg/m2or if earlier signs of iatrogenic myocardial damage was recognised: 5 cases in subgroup of 51 patients with baseline cardiovascular risk factors (9.8%). ADHF was observed in one of 17 patients (5.88%) receiving liposomal doxorubicin as second line chemotherapy after first line with conventional doxorubicin. Consequently throughout the study group ADHF didn't depend on the total cumulative dose of all types of doxorubicin: OR=0.85; 95%CI: 0.66-1.10; p=0.22 for each 50mg/m2.
  
  
  CONCLUSIONS
  The schedule of administration of conventional/liposomal doxorubicin can decide that lifetime combined doses of anthracyclines become insignificant for ADHF occurrence and premature discontinuation of chemotherapy in lymphoma patients with pre-existing cardiovascular disturbances.
authors.affiliation: Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, Otwock, Poland. Electronic address: sszmit@cmkp.edu.pl.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Szmit
authors.affiliation: Department of Hematology, Jagiellonian University, Kraków, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jurczak
authors.affiliation: Department of Propedeutic Oncology, Medical University of Gdansk & Gdynia Oncology Center, Gdynia, Poland.
authors.forename: Jan Maciej
authors.initials: JM
authors.lastname: Zaucha
authors.affiliation: Department of Hematology, Jagiellonian University, Kraków, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Długosz-Danecka
authors.affiliation: Department of Oncocardiology, Holycross Cancer Center, Kielce, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sosnowska-Pasiarska
authors.affiliation: Nicolaus Copernicus University in Toruń, Poland; Clinical Oncology Department, Oncology Center in Bydgoszcz, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Chmielowska
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Joks
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Drozd-Sokołowska
authors.affiliation: Hematology Department, Independent Public Health Care Ministry of the Interior of Warmia and Mazury Oncology Center, Olsztyn, Poland; University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Wanda
authors.initials: W
authors.lastname: Knopińska-Posłuszny
authors.affiliation: Internal Medicine and Oncology Clinic, Silesian Medical University, Katowice, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Spychałowicz
authors.affiliation: Departament of Hematooncology, Markiewicz Memorial Oncology Center, Brzozów, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Kumiega
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Charliński
authors.affiliation: Hematooncology and Bone Marrow Transplantation Clinic, Lublin, Poland; St. John's Cancer Center, Lublin, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Morawska
authors.affiliation: Department of Clinical Oncology, Regional Specialized Hospital No. 3, Rybnik, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Słomian
mesh_terms: D000208:Acute Disease; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006801:Humans; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries / Q000706:statistics & numerical data; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D000903:Antibiotics, Antineoplastic; D002316:Cardiotonic Agents; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin
keywords: Acute decompensated heart failure; Anthracyclines; Cardio-oncology; Chemotherapy; Liposomal doxorubicin; Lymphoma