Does the modification of chemotherapy reduce heart disease side effects in patients with Hodgkin lymphoma?

This study examined if a modified version of doxorubicin (Adriamycin) in ABVD chemotherapy was safe and effective in patients with Hodgkin’s lymphoma who had heart disease. This study found that this regimen was safer and just as effective as conventional ABVD.

Hodgkin’s lymphoma (HL) is a cancer of white blood cells. These cells are an important part of the body’s immune system and help fight infection. It is commonly treated by using a combination of chemotherapy drugs. The most common regimen is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). However, this regimen is associated with side effects to the heart. For elderly patients with HL, these side effects can make treatment challenging.

A modified version of doxorubicin called Myocet has been substituted for doxorubicin in a new regimen called MBVD. Previous studies have shown that MBVD was safer and more effective for patients with breast cancer who had heart disease. Elderly patients with HL may have other conditions such as heart disease, which makes treatment difficult.  This study examined if MBVD was as effective and safe for patients with HL over age 70, including patients with heart disease.

This study had 47 patients with untreated HL. 51% of patients had pre-existing heart problems.  Patients were divided into two groups based on disease stage. 13 patients with early-stage HL received 3 cycles of MBVD followed by radiotherapy. 34 patients with advanced-stage HL received 6 cycles of MBVD. Some of these patients also received radiotherapy localized to the tumor only. Patients were followed-up for an average of 40 months.

Overall, 77% of all patients had no detectable cancer after treatment. This rate was 100% for patients with early HL versus 68% for patients with advanced HL.

3 years after treatment, 78% of all patients were still alive. 59% of patients were still alive without the cancer growing or worsening. All patients with early HL disease were still alive 3 years later. 70% of patients with advanced HL were still alive. 43% of these patients were still alive without the cancer growing or worsening.

Most side effects were mild. The most common one was low white blood cell count (59.6%), followed by low red blood cell count (55.3%) and gut problems (34%). 4.3% of all patients (2 patients) with advanced HL experienced heart side effects.

Some serious side effects were reported. The most common one was low white blood cell count (48.9%). 6.3% of patients had low white blood cell count with fever, which can be life-threatening. 8.5% of patients had low red blood cell count. 14.8% of patients also reported serious infections.

This study concluded that MBVD is safe and effective for the treatment of elderly patients with HL, including patients with heart disease. The authors suggest that MBVD may be an alternative treatment option for patients who have heart problems and cannot tolerate conventional ABVD.

This study had a very small number of patients (47 patients). Larger studies directly comparing MBVD to ABVD treatment are needed.

Talk to your doctor about your treatment options if you have concerns about pre-existing heart problems.