Anthracycline treatment, cardiovascular risk factors and the cumulative incidence of cardiovascular disease in a cohort of newly diagnosed lymphoma patients from the modern treatment era

Nicholas J Boddicker; Melissa C Larson; Alessia Castellino; Joerg Herrmann; David J Inwards; Gita Thanarajasingam; Matthew J Maurer; Cristine Allmer; Thomas E Witzig; Grzegorz S Nowakowski; Thomas M Habermann; Hector R Villarraga; Susan L Slager; James R Cerhan; Carrie A Thompson

doi:10.1002/ajh.26230

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Anthracycline treatment, cardiovascular risk factors and the cumulative incidence of cardiovascular disease in a cohort of newly diagnosed lymphoma patients from the modern treatment era

Journal article

Peer reviewed

Anthracycline treatment, cardiovascular risk factors and the cumulative incidence of cardiovascular disease in a cohort of newly diagnosed lymphoma patients from the modern treatment era

Nicholas J Boddicker, Melissa C Larson, Alessia Castellino, Joerg Herrmann, David J Inwards, Gita Thanarajasingam, Matthew J Maurer, Cristine Allmer, Thomas E Witzig, Grzegorz S Nowakowski, …

American journal of hematology, Vol.96(8), pp.979-988

08/01/2021

DOI: 10.1002/ajh.26230

PMCID: PMC8665734

PMID: 33971040

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Abstract

The development of cardiovascular disease (CVD) in long-term survivors of lymphoma is of increasing importance. Here, we characterize the cumulative incidence and risk factors for CVD in lymphoma patients diagnosed in the current treatment era. From 2002-2015, newly diagnosed lymphoma patients (>18 years) were enrollment into a prospective cohort study that captured incident CVD, consisting of congestive heart failure (CHF), acute coronary syndrome (ACS), valvular heart disease (VHD), and arrhythmia. The cumulative incidence of CVD was calculated with death modeled as a competing risk. We estimated the association of treatment with anthracyclines or radiotherapy and traditional CVD risk factors with incidence of CVD using hazard ratios (HR) and 95% confidence intervals (CI) estimated from Cox regression. After excluding prevalent CVD at lymphoma diagnosis, the study consisted of 3063 patients with a median age of 59 years (range 18-95). The cumulative incidence of CVD at 10-years was 10.7% (95% CI, 9.5%-12.1%). In multivariable analysis, increasing age (HR = 1.05 per year, p < 0.001), male sex (HR = 1.36, p = 0.02), current smoker (HR = 2.10, p < 0.001), BMI > 30 kg/m (HR = 1.45, p = 0.01), and any anthracycline treatment (HR = 1.57, p < 0.001) were all significantly associated with risk of CVD. Anthracyclines were associated with increased risk of CHF (HR = 2.71, p < 0.001) and arrhythmia (HR = 1.61, p < 0.01), but not VHD (HR = 0.84, p = 0.58) or ACS (HR = 1.32, p = 0.24) after adjustment for CVD risk factors. Even in the modern treatment era, CVD remains common in lymphoma survivors and preventive efforts are required that address both treatment and CVD risk factors.

Adolescent

Adult

Aged

Aged, 80 and over

Anthracyclines - pharmacology

Anthracyclines - therapeutic use

Cardiovascular Diseases - physiopathology

Cohort Studies

Female

Humans

Lymphoma - complications

Lymphoma - pathology

Male

Middle Aged

Risk Factors

Young Adult

Details

Title: Subtitle: Anthracycline treatment, cardiovascular risk factors and the cumulative incidence of cardiovascular disease in a cohort of newly diagnosed lymphoma patients from the modern treatment era
Creators: Nicholas J Boddicker - Mayo Clinic
Melissa C Larson - Mayo Clinic
Alessia Castellino - Azienda Ospedaliera Citta' della Salute e della Scienza di Torino
Joerg Herrmann - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
David J Inwards - Mayo Clinic
Gita Thanarajasingam - Mayo Clinic
Matthew J Maurer - Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
Cristine Allmer - Mayo Clinic
Thomas E Witzig - Mayo Clinic
Grzegorz S Nowakowski - Mayo Clinic
Thomas M Habermann - Mayo Clinic
Hector R Villarraga - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Susan L Slager - Mayo Clinic
James R Cerhan - Mayo Clinic
Carrie A Thompson - Mayo Clinic
Resource Type: Journal article
Publication Details: American journal of hematology, Vol.96(8), pp.979-988
DOI: 10.1002/ajh.26230
PMID: 33971040
PMCID: PMC8665734
NLM abbreviation: Am J Hematol
ISSN: 0361-8609
eISSN: 1096-8652
Grant note: U01 CA195568 / NCI NIH HHS KL2 TR002379 / NCATS NIH HHS P50 CA97274 / NIH HHS P50 CA097274 / NCI NIH HHS
Language: English
Date published: 08/01/2021
Academic Unit: Epidemiology
Record Identifier: 9984368216702771

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