Evaluating the risk of heart complications after anthracycline treatment for patients with DLBCL or FL

This study evaluated the risk of developing congestive heart failure (CHF; the muscle of the heart becomes weak and does not pump blood efficiently) in patients with non-Hodgkin’s lymphoma (NHL) after first-line chemoimmunotherapy. This study concluded that treatment containing anthracyclines was associated with a significantly higher risk of developing CHF.

R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is the most common first-line treatment for patients with diffuse large B-cell lymphoma (DLBCL). However, anthracyclines such as doxorubicin (Adriamycin) have been associated with heart complications such as CHF and heart disease.

There are two types of CHF that may develop from anthracycline treatment. Acute CHF develops early, during treatment. CHF can also develop several years after treatment. The risk of patients with DLBCL or follicular lymphoma (FL) developing heart complications after first-line chemoimmunotherapy remains under investigation.

This study involved 2440 patients with DLBCL or FL. 1994 patients received first-line chemoimmunotherapy regimens with anthracyclines. 446 received anthracyclines-free treatment. Anthracycline-containing regimens included R-CHOP and R-CHOEP (R-CHOP plus etoposide). Patients were followed-up for an average of 3.8 to 3.9 years.

For all patients, five-year overall survival (patients still alive at 5 years; OS) was 85%. For anthracycline-treated patients, five-year OS was 86%. For patients treated without anthracyclines, five-year OS was 81%.

At follow-up, more patients treated with anthracyclines developed CHF (5.4%) compared to patients that did not (0.7%). More patients treated with anthracyclines developed heart disease compared to those anthracycline-free (12.2% vs. 5.2%).

The risk of developing CHF significantly increased with more cycles of treatment in anthracycline-treated patients. 3 to 5 cycles of treatment were significantly associated with a 5.0-fold higher risk of CHF. This risk was 6.8-fold higher after 6 cycles and 13.4-fold higher after more than 6 cycles.

This study concluded that treatment containing anthracyclines was associated with a significantly higher risk of developing CHF in patients with DLBCL and FL.

This study was retrospective, meaning it looked back in time to analyze data. Also, the number of patients treated with anthracyclines was much higher than those who did not receive anthracyclines. This may bias these results.