Increased Attention to Cardiovascular Events in DLBCL Warranted

San Diego, CA—Patients with diffuse large B-cell lymphoma (DLBCL) are at increased risk for cardiovascular (CV) events, particularly during the first year following diagnosis, and these events shorten their lives, according to a retrospective study presented at the 2016 Annual Meeting of the American Society of Hematology. In a multivariate analysis, older age and body mass index (BMI) >30 were significant risk factors for developing CV events in patients with DLBCL.

“One in 10 patients with DLBCL is likely to develop a CV event in the first year after diagnosis. These findings suggest that it is important to identify patients at high risk, monitor them, and apply cardioprotective strategies in patients with a history of cardiovascular disease, and in older patients, as well as those with increased BMI,” said lead author Sabarish Ram Ayyappan, MBBS, University Hospitals, Case Medical Center, Cleveland, OH.

DLBCL is the most common type of non-Hodgkin lymphoma, and it occurs more frequently in elderly patients. Median age at diagnosis is 65 years, which is the same age at which CV events typically begin to occur. Anthracycline-based chemotherapy is the standard of care for DLBCL, but it carries a risk for cardiotoxicity.

The retrospective analysis was based on 413 patients with DLBCL treated at Case Medical Center between 2001 and 2014. Data collected on patient characteristics included CV risk factors, disease characteristics, baseline cardiac function, treatment details, and outcomes, including response, relapse, and CV events.

Median age at diagnosis was 63 years, 54% of patients were men, and 139 patients were older than 70 years. DLBCL was aggressive in 62% of patients. Median BMI was 27.9. At baseline, 59% had stage III or IV disease; 398 were treated with chemotherapy, and of these, 88% received anthracyclines. During treatment, 52% received 6 cycles of chemotherapy.

At a median follow-up of 33 months, 46% (n = 19) of patients relapsed and 34% (n = 140) died. The 3-year overall survival rate was 70%, and the 3-year progression-free survival rate was 58.8%.

After diagnosis, 18% (n = 74) of patients developed approximately 100 CV events: 43 patients developed congestive heart failure; 10, asymptomatic heart failure; 18, atrial fibrillation; 4, arrhythmia; 1, myocardial infarction; 12, coronary artery disease; 7, cerebrovascular accident; and 3, other. The 1-year cumulative incidence was 9.7%, and the 3-year cumulative incidence was 14.7%.

In a univariate analysis, age >60 years; previous history of congestive heart failure, coronary artery disease, arterial hypertension, chronic obstructive pulmonary disease, and chronic renal failure; and BMI >30 were significantly associated with CV events (P <.05).

In a multivariate analysis, only age >60 years and BMI >30 remained significant (P = .010 and P = .001, respectively). Patients who experienced a CV event in the first year after diagnosis had an estimated 3-year overall survival rate of 49% compared with 71.7% in patients who did not experience a CV event in the first year (P = .002). “The effect remained the same regardless of exposure to anthracyclines,” Dr Ayyappan stated.

Study limitations include that it was a retrospective analysis with a potential selection bias, no standardized follow-up for CV monitoring, and incomplete data on cause of death.