How common are side effects of the heart in patients with non-Hodgkin lymphoma who receive CHOP or R-CHOP chemotherapy?

This study examined how common side effects of the heart, including heart failure, were among patients with non-Hodgkin lymphoma who received CHOP or R-CHOP chemotherapy. The results showed that only a minority developed side effects and that older patients and female patients were more likely to develop them.

Both non-Hodgkin lymphoma (NHL) and the chemotherapy used to treat it increase the risk of patients developing heart problems, including heart failure. These are serious and so their early detection and treatment are vital. 

Chemotherapy combinations often used to treat NHL include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), sometimes with rituximab (R-CHOP). Cyclophosphamide and doxorubicin are both known to affect heart health. However, it is not known exactly how many patients with NHL develop heart side effects, in particular heart failure.

The results of 137 studies that included 21211 patients with NHL that received either CHOP or R-CHOP were examined. The follow-up time ranged from 25.5 months to 52.8 months (the average was 39 months).

8.52% of patients experienced milder side effects of the heart. Overall, 2.35% of patients developed serious side effects of the heart. However, there was a big variation between studies with results ranging from 0 to 15.1%. 

Patients who were 65 years and older were 3.18 times more likely to develop serious side effects of the heart compared to patients under 65. Female patients were also more likely to develop serious side effects. The type of chemotherapy (CHOP versus R-CHOP) or the number of chemotherapy cycles did not affect their risk of side effects.

38 studies reported heart failure. These showed that 4.62% of patients developed heart failure. 1.64% of patients who were not evaluated reported heart failure compared to 11.72% who were evaluated after treatment. Patients who received a high number of chemotherapy cycles (more than 6) were 1.78 times more likely to develop heart side effects compared to patients who received a low number of cycles. The type of chemotherapy (CHOP versus R-CHOP) or the gender of patients did not affect their risk of heart failure. 

The authors concluded that while a minority of patients develop heart side effects, heart failure is detected more often by screening. The authors suggest that patients’ hearts should be monitored after treatment is completed.

This study was limited by the use of medical records data. This means that some information, such as patients’ smoking status or blood pressure, was not available to analyze. The different designs of the studies analyzed means that there was a large variation in results, including what was accepted a side effect.