Cardiac Monitoring Need Highlighted For Non-Hodgkin’s Lymphoma Patients

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: Cardiac monitoring helps identify cardiovascular adverse events (AEs) among non-Hodgkin’s lymphoma patients given first-line treatment with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) alone or with rituximab (R-CHOP), a systematic review and meta-analysis shows. 

“The considerable increase of reported heart failures with cardiac monitoring, indicates that this complication often remains undiagnosed in patients with non-Hodgkin lymphoma who received first-line R-CHOP or CHOP”, say Marijke Linschoten, from University Medical Centre Utrecht in the Netherlands, and colleagues. 

“Our findings are of importance to raise awareness of this complication among clinicians treating patients with non-Hodgkin lymphoma and stresses the need for cardiac monitoring during and after chemotherapy”, they write in The Lancet Haematology. 

“Prompt initiation of treatment for heart failure in the presymptomatic phase can mitigate the progression to more advanced heart failure stages.” 

The investigators collated data for 21,211 patients in 137 studies between 1984 and 2019 who received CHOP (n=9541), R-CHOP (n=11,293) or both regimens (n=377) and were followed up for a median of 39 months. 

Pooled data from 14,351 participants of 77 studies revealed that 2.35% of patients experienced grade 3 or 4 cardiovascular AEs, with “a particularly high risk of severe cardiovascular adverse events” noted among women and patients aged at least 65 years. 

Meanwhile, pooled data for 5936 patients included in 38 studies showed that 4.62% of the cohort experienced heart failure. However, this rate was significantly higher among patients who underwent cardiac screening after chemotherapy than those who did not, at 11.72% versus 1.64%.  

“Our findings stress the importance of close multidisciplinary collaboration between (haemato-)oncologists and cardiologists for the early detection of cardiovascular complications in the pre-symptomatic phase, enabling targeted prevention strategies to improve long-term cardiac outcome in survivors of non-Hodgkin lymphomas”, the researchers say. 

And they suggest: “Our results can presumably also be generalised to non-Hodgkin lymphoma patients receiving a regimen of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin with or without rituximab (DA-EPOCH[-R]), since the regimen contains comparable doses of doxorubicin.”

Reference 

Linschoten M, Kamphuis JAM, van Rhenen A, et al. Cardiovascular adverse events in patients with non-Hodgkin lymphoma treated with first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP with rituximab (R-CHOP): a systematic review and meta-analysis. Lancet Haematol; Advance online publication 2 March 2020. https://doi.org/10.1016/S2352-3026(20)30031-4