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Didier R, Durand A, Boulin M, Caillot D, Bodin A, Herbert J, Bonnotte B, Zeller M, Cottin Y, Fauchier L. Deaths and major cardiovascular events in patients with lymphoma: Analysis from a French nationwide hospitalization database. Arch Cardiovasc Dis 2024:S1875-2136(24)00213-4. [PMID: 38965010 DOI: 10.1016/j.acvd.2024.05.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND There are few data assessing the risk of death and cardiovascular events in patients with lymphoma. AIM Using a nationwide hospitalization database, we aimed to address cardiovascular outcomes in patients with lymphoma. METHODS From 01 January to 31 December 2013, 3,381,472 adults were hospitalized in French hospitals; 22,544 of these patients had a lymphoma. The outcome analysis (all-cause or cardiovascular death, myocardial infarction, ischaemic stroke, bleedings, new-onset heart failure and new-onset atrial fibrillation) was performed over a 5-year follow-up period. Each patient with lymphoma was matched with a patient without a lymphoma or other cancer (1:1). A competing risk analysis was also performed. RESULTS After adjustment on all risk factors, cardiovascular and non-cardiovascular co-morbidities, the subdistribution hazard ratios for all-cause death, major bleeding, intracranial bleeding, new-onset heart failure and new-onset atrial fibrillation were higher in patients with lymphoma; conversely, the subdistribution hazard ratios for cardiovascular death, myocardial infarction and ischaemic stroke were lower in patients with lymphoma. In the matched analysis, the risk of all-cause death (subdistribution hazard ratio 1.936, 95% confidence interval 1.881-1.992) and major bleeding (subdistribution hazard ratio 1.117, 95% confidence interval 1.049-1.188) remained higher in patients with lymphoma. CONCLUSION In this large nationwide cohort study, patients with lymphoma had a higher incidence of all-cause death and major bleeding.
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Affiliation(s)
- Romain Didier
- Cardiology Department, Dijon University Hospital, 21000 Dijon, France
| | - Amandine Durand
- Haematology Department, Dijon University Hospital, 21000 Dijon, France
| | - Mathieu Boulin
- Pharmacy Department, EPICAD LNC-UMR 1231, University of Bourgogne Franche Comté, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - Denis Caillot
- Haematology Department, Dijon University Hospital, 21000 Dijon, France
| | - Alexandre Bodin
- Cardiology Department, Trousseau Hospital, University François Rabelais, 37170 Chambray-lès-Tours, France
| | - Julien Herbert
- Cardiology Department, Trousseau Hospital, University François Rabelais, 37170 Chambray-lès-Tours, France
| | - Bernard Bonnotte
- Haematology Department, Dijon University Hospital, 21000 Dijon, France
| | - Marianne Zeller
- Cardiology Department, Dijon University Hospital, 21000 Dijon, France; PEC2, EA 7460, University of Bourgogne Franche Comté, 21000 Dijon, France
| | - Yves Cottin
- Cardiology Department, Dijon University Hospital, 21000 Dijon, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau Hospital, University François Rabelais, 37170 Chambray-lès-Tours, France
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Rankin S, Fountain C, Gemmell AJ, Quinn D, Henderson A, McClure J, Small S, Venugopal B, McKay P, Slomka PJ, Colville D, Petrie MC, Meléndez GC, Lang NN. Arterial effects of anthracycline: structural and inflammatory assessments in non-human primates and lymphoma patients using 18F-FDG positron emission tomography. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.30.596741. [PMID: 38895275 PMCID: PMC11185566 DOI: 10.1101/2024.05.30.596741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Background Anthracyclines, such as doxorubicin, are important anti-cancer therapies but are associated with arterial injury. Histopathological insights have been limited to small animal models and the role of inflammation in the arterial toxic effects of anthracycline is unclear in humans. Our aims were: 1) To evaluate aortic media fibrosis and injury in non-human primates treated with anthracyclines; 2) To assess the effect of anthracycline on aortic inflammation in patients treated for lymphoma. Methods 1) African Green monkeys (AGM) received doxorubicin (30-60 mg/m2/biweekly IV, cumulative dose: 240 mg/m2). Blinded histopathologic analyses of collagen deposition and cell vacuolization in the ascending aorta were performed 15 weeks after the last doxorubicin dose and compared to 5 age- and gender-matched healthy, untreated AGMs. 2) Analysis of the thoracic aorta of patients with diffuse large B-cell lymphoma (DLBCL), at baseline and after doxorubicin exposure, was performed using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in this observational study. The primary outcome was change in maximal tissue-to-background ratio (TBRmax) of the thoracic aorta from baseline to their end-of-treatment clinical PET/CT. Results In AGMs, doxorubicin exposure was associated with greater aortic fibrosis (collagen deposition: doxorubicin cohort 6.23±0.88% vs. controls 4.67±0.54%; p=0.01) and increased intracellular vacuolization (doxorubicin 66.3 ± 10.1 vs controls 11.5 ± 4.2 vacuoles/field, p<0.0001) than untreated controls.In 101 patients with DLBCL, there was no change in aortic TBRmax after anthracycline exposure (pre-doxorubicin TBRmax 1.46±0.16 vs post-doxorubicin TBRmax 1.44±0.14, p=0.14). The absence of change in TBRmax was consistent across all univariate analyses. Conclusions In a large animal model, anthracycline exposure was associated with aortic fibrosis. In patients with lymphoma, anthracycline exposure was not associated with aortic inflammation.Further research is required to elucidate the mechanisms of anthracycline-related vascular harm.
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Affiliation(s)
- Stephen Rankin
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow UK
| | - Caitlin Fountain
- Departments of Internal Medicine, Section on Cardiology and Pathology, Section on Comparative Medicine. Wake Forest University School of Medicine, Winston-Salem, USA
| | - Alastair J Gemmell
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde, Glasgow
- School of Medicine, Dentistry and Nursing, University of Glasgow
| | - Daire Quinn
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Alasdair Henderson
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow UK
| | - John McClure
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow UK
| | - Sandy Small
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde, Glasgow
- School of Medicine, Dentistry and Nursing, University of Glasgow
| | - Balaji Venugopal
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow
| | - Pamela McKay
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Piotr J Slomka
- Cedars-Sinai, Division of Artificial Intelligence in Medicine, Department of Medicine, Los Angeles, USA
| | - David Colville
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow UK
- School of Medicine, Dentistry and Nursing, University of Glasgow
| | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow UK
| | - Giselle C. Meléndez
- Departments of Internal Medicine, Section on Cardiology and Pathology, Section on Comparative Medicine. Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ninian N Lang
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow UK
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Vakilpour A, Lefebvre B, Lai C, Scherrer-Crosbie M. Heartbreaker: Detection and prevention of cardiotoxicity in hematological malignancies. Blood Rev 2024; 64:101166. [PMID: 38182490 DOI: 10.1016/j.blre.2023.101166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
Cancer survivors are at significant risk of cardiovascular (CV) morbidity and mortality; patients with hematologic malignancies have a higher rate of death due to heart failure compared to all other cancer subtypes. The majority of conventional hematologic cancer treatments is associated with increased risk of acute and long-term CV toxicity. The incidence of cancer therapy induced CV toxicity depends on the combination of patient characteristics and on the type, dose, and duration of the therapy. Early diagnosis of CV toxicity, appropriate referral, more specific cardiac monitoring follow-up and timely interventions in target patients can decrease the risk of CV adverse events, the interruption of oncological therapy, and improve the patient's prognosis. Herein, we summarize the CV effects of conventional treatments used in hematologic malignancies with a focus on definitions and incidence of the most common CV toxicities, guideline recommended early detection approaches, and preventive strategies before and during cancer treatments.
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Affiliation(s)
- Azin Vakilpour
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Bénédicte Lefebvre
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; The Thalheimer Center for Cardio-oncology, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Catherine Lai
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; The Thalheimer Center for Cardio-oncology, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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4
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 797] [Impact Index Per Article: 398.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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5
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Žaliaduonytė D, Kleinauskienė R, Muckienė G, Zabiela V. Cardiovascular Disorder after Cardiotoxic Non-Hodking’s Lymphoma Treatment: A Case Report. Medicina (B Aires) 2022; 58:medicina58040489. [PMID: 35454328 PMCID: PMC9031904 DOI: 10.3390/medicina58040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
The non-Hodgkin’s lymphomas are a diverse group of lymphoid neoplasms that collectively rank fifth in cancer incidence and mortality. Patients treated with mediastinal radiotherapy and/or anthracycline-containing chemotherapy are known to have increased risks of coronary heart disease, valvular heart disease, and heart failure. This may be the result of cancer treatment cardiotoxicity or may be due to accelerated development of cardiovascular disease. We presented 41-year-old male who was admitted to the hospital because of congestive heart failure. He has a medical history of non-Hodgkin’s lymphoma treated with anthracycline-based chemotherapy and mediastinal radiotherapy almost 20 years ago. Echocardiography showed significant aortic valve stenosis, thickened and fibrotic pericardium. Coronary angiography showed diffuse three-vessel coronary artery disease. The patient was referred for surgical treatment. Aortic valve replacement, coronary artery bypass grafting and pericardiectomy were successfully performed, symptoms of heart failure reduced.
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Affiliation(s)
- Diana Žaliaduonytė
- Department of Cardiology, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eivenių St. 2, 50161 Kaunas, Lithuania; (G.M.); (V.Z.)
- Medical Academy, Lithuanian University of Health Sciences, Mickeviciaus St. 9, 44307 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Correspondence: (D.Ž.); (R.K.)
| | - Rita Kleinauskienė
- Department of Cardiology, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eivenių St. 2, 50161 Kaunas, Lithuania; (G.M.); (V.Z.)
- Correspondence: (D.Ž.); (R.K.)
| | - Gintarė Muckienė
- Department of Cardiology, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eivenių St. 2, 50161 Kaunas, Lithuania; (G.M.); (V.Z.)
- Medical Academy, Lithuanian University of Health Sciences, Mickeviciaus St. 9, 44307 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eivenių St. 2, 50161 Kaunas, Lithuania; (G.M.); (V.Z.)
- Medical Academy, Lithuanian University of Health Sciences, Mickeviciaus St. 9, 44307 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
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Díaz-Antón B, Madurga R, Zorita B, Wasniewski S, Moreno-Arciniegas A, López-Melgar B, Ramírez Merino N, Martín-Asenjo R, Barrio P, Amado Escañuela MG, Solís J, Parra Jiménez FJ, Ciruelos E, Castellano JM, Fernández-Friera L. Early detection of anthracycline- and trastuzumab-induced cardiotoxicity: value and optimal timing of serum biomarkers and echocardiographic parameters. ESC Heart Fail 2022; 9:1127-1137. [PMID: 35106939 PMCID: PMC8934964 DOI: 10.1002/ehf2.13782] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/13/2021] [Accepted: 12/14/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS To evaluate echocardiographic and biomarker changes during chemotherapy, assess their ability to early detect and predict cardiotoxicity and to define the best time for their evaluation. METHODS AND RESULTS Seventy-two women with breast cancer (52 ± 9.8 years) treated with anthracyclines (26 also with trastuzumab), were evaluated for 14 months (6 echocardiograms/12 laboratory tests). We analysed: high-sensitivity cardiac troponin T, NT-proBNP, global longitudinal strain (GLS), left ventricle end-systolic volume (LVESV), left ventricle end-diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF). Cardiotoxicity was defined as a reduction in LVEF>10% compared with baseline with LVEF<53%. High-sensitivity troponin T levels rose gradually reaching a maximum peak at 96 ± 13 days after starting chemotherapy (P < 0.001) and 62.5% of patients presented increased values during treatment. NT-proBNP augmented after each anthracycline cycle (mean pre-cycle levels of 72 ± 68 pg/mL and post-cycle levels of 260 ± 187 pg/mL; P < 0.0001). Cardiotoxicity was detected in 9.7% of patients (mean onset at 5.2 months). In the group with cardiotoxicity, the LVESV was higher compared with those without cardiotoxicity (40 mL vs. 29.5 mL; P = 0.045) at 1 month post-anthracycline treatment and the decline in GLS was more pronounced (-17.6% vs. -21.4%; P = 0.03). Trastuzumab did not alter serum biomarkers, but it was associated with an increase in LVESV and LVEDV (P < 0.05). While baseline LVEF was an independent predictor of later cardiotoxicity (P = 0.039), LVESV and GLS resulted to be early detectors of cardiotoxicity [odds ratio = 1.12 (1.02-1.24), odds ratio = 0.66 (0.44-0.92), P < 0.05] at 1 month post-anthracycline treatment. Neither high-sensitivity troponin T nor NT-proBNP was capable of predicting subsequent cardiotoxicity. CONCLUSIONS One month after completion of anthracycline treatment is the optimal time to detect cardiotoxicity by means of imaging parameters (LVESV and GSL) and to determine maximal troponin rise. Baseline LVEF was a predictor of later cardiotoxicity. Trastuzumab therapy does not affect troponin values hence imaging techniques are recommended to detect trastuzumab-induced cardiotoxicity.
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Affiliation(s)
- Belén Díaz-Antón
- Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Melchor Fernández Almagro 3, Madrid, 28029, Spain.,Unidad de Imagen Cardiaca, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain.,Universidad CEU San Pablo, Madrid, Spain.,Atria Clinic, Madrid, Spain
| | - Rodrigo Madurga
- Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, Spain.,Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - Blanca Zorita
- Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Melchor Fernández Almagro 3, Madrid, 28029, Spain
| | - Samantha Wasniewski
- Unidad de Imagen Cardiaca, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain
| | - Andrea Moreno-Arciniegas
- Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Melchor Fernández Almagro 3, Madrid, 28029, Spain.,Unidad de Imagen Cardiaca, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain
| | - Beatriz López-Melgar
- Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Melchor Fernández Almagro 3, Madrid, 28029, Spain.,Unidad de Imagen Cardiaca, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain
| | - Natalia Ramírez Merino
- Universidad CEU San Pablo, Madrid, Spain.,Departamento de Oncología Médica, HM Hospitales, Madrid, Spain
| | | | - Patricia Barrio
- Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Melchor Fernández Almagro 3, Madrid, 28029, Spain.,Unidad de Imagen Cardiaca, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain
| | - Maximiliano German Amado Escañuela
- Unidad de Imagen Cardiaca, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain.,Hospital General de Segovia, Segovia, Spain
| | - Jorge Solís
- Atria Clinic, Madrid, Spain.,Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Francisco Javier Parra Jiménez
- Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Melchor Fernández Almagro 3, Madrid, 28029, Spain
| | - Eva Ciruelos
- Departamento de Oncología Médica, HM Hospitales, Madrid, Spain.,Servicio Oncología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José María Castellano
- Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Melchor Fernández Almagro 3, Madrid, 28029, Spain.,Universidad CEU San Pablo, Madrid, Spain.,Atria Clinic, Madrid, Spain.,Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Leticia Fernández-Friera
- Unidad de Imagen Cardiaca, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain.,Universidad CEU San Pablo, Madrid, Spain.,Atria Clinic, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
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8
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Ekberg S, Harrysson S, Jernberg T, Szummer K, Andersson PO, Jerkeman M, Smedby KE, Eloranta S. Myocardial infarction in diffuse large B-cell lymphoma patients - a population-based matched cohort study. J Intern Med 2021; 290:1048-1060. [PMID: 34003533 DOI: 10.1111/joim.13303] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The outcome for diffuse large B-cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R-CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. METHOD We identified 3548 curatively treated DLBCL patients in Sweden diagnosed between 2007 and 2014, and 35474 matched lymphoma-free general population comparators. The incidence, characteristics and outcome of acute myocardial infarctions (AMIs) were assessed using population-based registers up to 11 years after diagnosis. The rate of AMI was estimated using flexible parametric models. RESULTS Overall, a 33% excess rate of AMI was observed among DLBCL patients compared with the general population (HR: 1.33, 95% CI: 1.14-1.55). The excess rate was highest during the first year after diagnosis and diminished after 2 years. High age, male sex and comorbidity were the strongest risk factors for AMI. Older patients (>70 years) with mild comorbidities (i.e. hypertension or diabetes) had a 61% higher AMI rate than comparators (HR: 1.61, 95% CI: 1.10-2.35), whereas the corresponding excess rate was 28% for patients with severe comorbidities (HR: 1.28, 95% CI: 1.01-1.64). Among younger patients (≤70), a short-term excess rate of AMI was limited to those with severe comorbidities. There was no difference in AMI characteristics, pharmacological treatment or 30-day survival among patients and comparators. CONCLUSION DLBCL patients have an increased risk of AMI, especially during the first 2 years, which calls for improved cardiac monitoring guided by age and comorbidities. Importantly, DLBCL was not associated with differential AMI management or survival.
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Affiliation(s)
- S Ekberg
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - S Harrysson
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - T Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K Szummer
- Section of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - P-O Andersson
- Department of Hematology, South Älvsborg Hospital, Borås, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - M Jerkeman
- Division of Oncology, Lund University and Skane University Hospital, Lund, Sweden
| | - K E Smedby
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - S Eloranta
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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9
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Kwan JM, Henry ML, Cook K, Higgins A, Cuomo J, Foss F, Baldassarre LA. Adverse cardiovascular events in patients treated with mogamulizumab. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 9:100049. [PMID: 38559371 PMCID: PMC10978139 DOI: 10.1016/j.ahjo.2021.100049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 04/04/2024]
Abstract
Study objectives Mogamulizumab is an important treatment for T-cell leukemia and lymphoma. Adverse cardiovascular events (ACE) after mogamulizumab therapy have not been investigated. The aim of the study is to investigate ACE occurrence after mogamulizumab therapy. Methods The International World Health Organization database, VigiBase, was analyzed from January 2013 to August 2019 for all adverse events, including ACE, that occurred after mogamulizumab treatment. ACE was defined as: cardiac death, myocardial infarction, heart failure, myocarditis, arrhythmia, vasculitis, thrombosis, palpitations and new hypertension. Results ACE after mogamulizumab therapy affected 28 out of 650 unique patients (4.3%). Heart failure (42.8%) and ventricular arrhythmias (17.85%) were most common. ACE accounted for 10% of all fatal adverse outcomes, and 25% of all ACE were fatal. Time to fatal outcome was significantly shorter for patients with ACE compared to non-cardiovascular events, with a mean of 7.7 days (SD 6.91) vs 73 days (SD 90.7), p = 0.017, respectively. There was an increased total number of adverse cardiovascular events in patients greater than 65 and in Asian countries. Conclusions Cardiovascular toxicity with mogamulizumab is a possible early occurring adverse outcome associated with high mortality.
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Affiliation(s)
- Jennifer M. Kwan
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Mariana L. Henry
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Kirstin Cook
- Department of Neurosurgery, University of California, Los Angeles School of Medicine, Los Angeles, CA, United States of America
| | - Angela Higgins
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jason Cuomo
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Francine Foss
- Section of Hematology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Lauren A. Baldassarre
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
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10
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Jafari E, Amini AL, Ahmadzadehfar H, Bagheri D, Assadi M. Cardiotoxicity and cardiac monitoring following the use of radiotheranostics agents including 177Lu-PSMA for prostate cancer and 177Lu-DOTATATE for neuroendocrine tumors. Nuklearmedizin 2021; 60:99-105. [PMID: 33461224 DOI: 10.1055/a-1332-8230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to determine the probable cardiotoxicity following radionuclide therapy (RNT), specifically peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE and radioligand therapy (RLT) with 177Lu-PSMA by evaluation of serum troponin I and cardiac profile change during a follow-up time. MATERIALS AND METHODS Patients with prostate cancer and neuroendocrine tumours (NETs) referred for PRRT and RLT, respectively, were enrolled in this study. The cardiac profiles of the patients were evaluated by a cardiologist and a cardiac history was obtained from all patients. Also, troponin I was measured before and 48 hours after treatment. RESULTS In this retrospective study for assessment of RLT associated cardiotoxicity, 24 patients were evaluated with a median age of 64 years (27-99 years) including 13 NET patients and 11 prostate cancer patients. Patients were followed up for 4 to 31 months which no cardiovascular problem was observed. In evaluation of troponin I, 39 RNT cycles were evaluated. In all patients, the value of troponin I was in normal range. In all patients, the median values of serum troponin I before and after treatment were 0.2 ± 0.02 (range: 0.00-0.42) and 0.28 ± 0.02 (range: 0.00-0.46) ng/ml, respectively (p > 0.05). In the prostate cancer patients, the median values of serum troponin I before and after treatment were 0.26 ± 0.04 (0.04-0.42) and 0.30 ± 0.04 (0.00-0.41) ng/ml, respectively (p > 0.05). In the NET patients, the median values of serum troponin I before and after treatment were 0.18 ± 0.03 (0.00-0.42) and 0.17 ± 0.03 (0.00-0.46) ng/ml, respectively (p > 0.05). CONCLUSION PRRT with 177Lu-DOTATATE and RLT with 177Lu-PSMA as emerging therapeutic modalities have no significant cardiotoxicity. However, further well-designed studies are recommended.
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Affiliation(s)
- Esmail Jafari
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abdul Latif Amini
- Bushehr Heart Medical center, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Dara Bagheri
- Department of Fisheries, Faculty of Agriculture and Natural Resources, Persian Gulf University, Bushehr, Iran
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
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11
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Rink JS, Lin AY, McMahon KM, Calvert AE, Yang S, Taxter T, Moreira J, Chadburn A, Behdad A, Karmali R, Thaxton CS, Gordon LI. Targeted reduction of cholesterol uptake in cholesterol-addicted lymphoma cells blocks turnover of oxidized lipids to cause ferroptosis. J Biol Chem 2021; 296:100100. [PMID: 33208460 PMCID: PMC7949030 DOI: 10.1074/jbc.ra120.014888] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022] Open
Abstract
Normal human cells can either synthesize cholesterol or take it up from lipoproteins to meet their metabolic requirements. In some malignant cells, de novo cholesterol synthesis genes are transcriptionally silent or mutated, meaning that cholesterol uptake from lipoproteins is required for survival. Recent data suggest that lymphoma cells dependent upon lipoprotein-mediated cholesterol uptake are also subject to ferroptosis, an oxygen- and iron-dependent cell death mechanism triggered by accumulation of oxidized lipids in cell membranes unless the lipid hydroperoxidase, glutathione peroxidase 4 (GPX4), reduces these toxic lipid species. To study mechanisms linking cholesterol uptake with ferroptosis and determine the potential role of the high-density lipoprotein (HDL) receptor as a target for cholesterol depleting therapy, we treated lymphoma cell lines known to be sensitive to the reduction of cholesterol uptake with HDL-like nanoparticles (HDL NPs). HDL NPs are a cholesterol-poor ligand that binds to the receptor for cholesterol-rich HDLs, scavenger receptor type B1 (SCARB1). Our data reveal that HDL NP treatment activates a compensatory metabolic response in treated cells toward increased de novo cholesterol synthesis, which is accompanied by nearly complete reduction in expression of GPX4. As a result, oxidized membrane lipids accumulate, leading to cell death through a mechanism consistent with ferroptosis. We obtained similar results in vivo after systemic administration of HDL NPs in mouse lymphoma xenografts and in primary samples obtained from patients with lymphoma. In summary, targeting SCARB1 with HDL NPs in cholesterol uptake-addicted lymphoma cells abolishes GPX4, resulting in cancer cell death by a mechanism consistent with ferroptosis.
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Affiliation(s)
- Jonathan S Rink
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois, USA; Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Adam Yuh Lin
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Kaylin M McMahon
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Andrea E Calvert
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Shuo Yang
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Tim Taxter
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan Moreira
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Amy Chadburn
- Department of Pathology, Weill Cornell Medical Center, New York, New York, USA
| | - Amir Behdad
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Reem Karmali
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - C Shad Thaxton
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois, USA; Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA; International Institute for Nanotechnology, Northwestern University, Evanston, Illinois, USA.
| | - Leo I Gordon
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA.
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12
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Mallouppas M, Walker JM, Guha A, Dobson R, Ghosh AK. Cardio-oncology for the general physician: 'old' and 'new' cardiovascular toxicities and how to manage them. Br J Hosp Med (Lond) 2020; 81:1-11. [PMID: 32990088 DOI: 10.12968/hmed.2020.0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardio-oncology is the care of cancer patients with cardiovascular disease. The need for a dedicated subspecialty emerged to address heart failure caused by drugs such as anthracyclines and anti-human epidermal growth factor receptor 2 (HER2) therapies, but over time has expanded into an exciting subspecialty with widening horizons. While still dealing with a lot of commonly recognised toxicities, such as heart failure, hypertension and coronary disease, new and revolutionary cancer therapies have been associated with challenging cardiovascular complications, requiring specialist input to manage effectively. Echocardiography is a key investigation, with advanced techniques such as three-dimensional and strain assessment allowing more accurate diagnosis and earlier detection of subtle changes. Cardiac magnetic resonance and biomarkers are useful adjuncts to aid diagnosis and management. With increasing cancer incidence and improved cancer survival rates, it is important that general cardiologists and physicians are aware of cardiac complications associated with cancer and how to manage them.
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Affiliation(s)
- Michael Mallouppas
- Cardio-Oncology Service, University College London Hospital NHS Foundation Trust, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
| | - J Malcolm Walker
- Cardio-Oncology Service, University College London Hospital NHS Foundation Trust, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Arjun K Ghosh
- Cardio-Oncology Service, University College London Hospital NHS Foundation Trust, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK.,Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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13
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Verberne HJ, Verschure DO. Anthracycline-induced cardiotoxicity: Is there a role for myocardial 123I-mIBG scintigraphy? J Nucl Cardiol 2020; 27:940-942. [PMID: 30603895 DOI: 10.1007/s12350-018-01584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Hein J Verberne
- Department of Radiology and Nuclear Medicine, F2-238, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Derk O Verschure
- Department of Radiology and Nuclear Medicine, F2-238, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands
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14
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Nagl L, Koinig K, Hofer F, Stauder R. Comorbidities cluster with impaired functional capacities and depressive mood and predict adverse outcome in older patients with hematological malignancies. Leuk Lymphoma 2020; 61:1954-1964. [PMID: 32281446 DOI: 10.1080/10428194.2020.1747063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study evaluates prevalence of comorbidities and their association with impairments in older patients with hematological malignancies at initial diagnosis (n = 209). At least one comorbidity was present in 62.2%, 68.5% and 93.8% as defined by CCI (Charlson Comorbidity Index), Cumulative Illness Rating Scale-Geriatric (CIRS-G) and HCT-Comorbidity Index, respectively. Severe comorbidities (CIRS-G Grade 3/4) were present in 57.9%. The mean number of affected organ systems was 3.6 (CIRS-G categories), with diabetes (18.2%), congestive heart failure and prior solid tumors (each 17.7%) detected most frequently. Comorbidities were significantly correlated with reduced functional and objective physical capacities, impaired performance and depressive mood. Both CCI and CIRS-G were found to be prognostic factors for OS (p < 0.05). CCI scoring of comorbidities, diagnosis MDS/AML and a body mass index <23kg/m2 were independent adverse predictors for OS. This first prospective analysis reveals a prognostic significance of comorbidities. Clustering of comorbidities with impairments suggests common mechanisms.
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Affiliation(s)
- Laurenz Nagl
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Karin Koinig
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Hofer
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
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15
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Trotman J, Cheah CY, Marlton P, Opat S. Front-line management of non-Hodgkin lymphoma in Australia. Part 1: follicular lymphoma. Intern Med J 2020; 49:422-433. [PMID: 30230156 DOI: 10.1111/imj.14113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/29/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Outcomes with follicular lymphoma (FL) have improved in the modern era and median survival is now beyond 15 years. Therapeutic decisions need to consider this increased survival as well as recent clinical trial data and emerging treatments. In this context, we present here current approaches to front-line management of FL in Australia. Treatment choices depend on the disease stage, tumour burden, the patient's age, symptoms, comorbidities and preferences. Only about 10-15% of patients with FL are diagnosed with early stage disease. For patients with low-grade, early stage disease, radiotherapy (RT) is recommended. The addition of chemotherapy has been shown to increase progression-free survival (PFS) but without demonstrated overall survival advantage. For patients with low-tumour-burden, advanced-stage FL, immediate treatment may not be required and we recommend considering active monitoring. For stage III/IV disease that is symptomatic and/or with high tumour burden, established first-line treatment is chemotherapy in combination with rituximab, often followed by rituximab maintenance. The listing of bendamustine and now obinutuzumab on the Pharmaceutical Benefits Scheme has expanded the first-line treatment options in Australia to include bendamustine in combination with rituximab (without rituximab maintenance permitted) or with obinutuzumab plus 2 years obintuzumab maintenance. In the FL subgroup of the Study group indolent Lymphomas (StiL) trial, therapy with bendamustine plus rituximab significantly increased PFS compared with rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone, without rituximab maintenance. Initial tolerability may be more favourable with bendamustine in combination with anti-CD20 antibody therapy than other therapies overall, but clinical vigilance is still required because of concerns of late infectious toxicities associated with prolonged T-cell depletion.
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Affiliation(s)
- Judith Trotman
- Department of Haematology, Concord Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Paula Marlton
- Division of Cancer Services, Clinical Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Stephen Opat
- Clinical Haematology and School of Clinical Sciences, Monash Health, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Masson R, Titievsky L, Corley DA, Zhao W, Lopez AR, Schneider J, Zaroff JG. Incidence rates of cardiovascular outcomes in a community-based population of cancer patients. Cancer Med 2019; 8:7913-7923. [PMID: 31668001 PMCID: PMC6912043 DOI: 10.1002/cam4.2657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 01/20/2023] Open
Abstract
Background There are limited data on the incidence of cardiovascular disease among cancer patients in the pre‐tyrosine kinase inhibitor (TKI) era. Such data are important in order to contextualize the incidence of various cardiovascular outcomes among cancer patients enrolled in clinical trials of new agents and for postmarketing surveillance. Methods A retrospective cohort study was conducted using data from the Kaiser Permanente Northern California (KPNC) population of cancer patients. The inclusion criterion was a KPNC Cancer Registry diagnosis of any of several selected solid and hematologic tumors between 1997 and 2009 not treated with a TKI. Endpoints were identified using ICD‐9 codes and included acute coronary syndrome, heart failure, stroke, cardiac arrest, hypertension, venous thromboembolism, all‐cause mortality, and cardiovascular mortality. Event rates were calculated according to type of cancer and number of cardiovascular risk factors. Results The study included almost 165 000 individuals with a broad variety of tumor types. The parent cohort was 54% female and 35% were ≥70 years old. Cardiovascular risk factors such as diabetes mellitus (14% of patients with solid tumors, 15% of patients with liquid tumors), dyslipidemia (33%, 31%), hypertension (50%, 49%), and smoking (35%, 32%) were common. The most frequent adverse outcomes were incident hypertension (26.8‐61.0 cases per 1000 person‐years, depending on the type of cancer), heart failure (9.4‐78.7), and acute coronary syndrome (2.6‐48.1). These event rates are high compared to what has been reported in prior KPNC cohort studies of patients without cancer. The rates of acute coronary syndrome, heart failure, and ischemic stroke increased with increasing numbers of cardiovascular risk factors. Conclusions In a population of patients with cancer not exposed to TKIs, cardiovascular risk factors and outcomes are very common, regardless of cancer type. These data can inform the evaluation of potential excess cardiovascular risks from new interventions.
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Affiliation(s)
- Rajeev Masson
- Kaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
| | | | - Douglas A. Corley
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Wei Zhao
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Alfredo R. Lopez
- Kaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
| | | | - Jonathan G. Zaroff
- Kaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
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17
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The Conundrum of Septic Shock Imitators in Patients with Hematologic Cancers: Case Presentation and Possible Differential Diagnoses. Case Rep Crit Care 2019; 2019:6561018. [PMID: 31583137 PMCID: PMC6754887 DOI: 10.1155/2019/6561018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/04/2019] [Accepted: 07/15/2019] [Indexed: 11/27/2022] Open
Abstract
The authors describe the case of a patient treated with several cycles of chemotherapy due to an advanced stage non-Hodgkin lymphoma. One daafter the last cycle, he was admitted to our Intensive Care Unit with a septic shock-like clinical picture which didn't respond to the aggressive treatment and the patient died a few hours later. The autoptical findings cast some doubts on the diagnosis, and demonstrated the presence of other factors imitating its symptoms. In this article, the mimickers of septic shock are reviewed and discussed, as some of them require an aggressive immunosuppression instead of the recommended treatment for septic shock.
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18
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Belenkov YN, Ershov VI, Antyufeeva ON, Budanova DA, Kochkareva YB, Gadaev IY, Bochkarnikova OV, Sokolova IY, Kirichenko YY. [Assessment of the Role of Oxidative Stress Indicators and Early Markers of Myocardial Injury and Disfunction in Patients with Lymphoproliferative Diseases]. KARDIOLOGIIA 2019; 59:47-53. [PMID: 31397229 DOI: 10.18087/cardio.2019.8.n682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE to study dynamics of indicators of oxidative stress and their role in development of cardiotoxicity in patients with lympho-proliferative diseases at the background of polychemotherapy. MATERIALS AND METHODS We included into this study 30 patients with newly detected Non-Hodgkin lymphomas. The control group comprised 15 healthy volunteers. For registration of dynamics of formation of oxygen active forms (OAF), we used highly sensitive chemiluminescence assay. The state of initial stage of lipoperoxidation OAF and radicals of organic compounds) was assessed by dynamics of the leukocyte chemiluminescence. The state of final stage of lipoperoxidation (formation of nonmetabolizing lipid hydroperoxides and other compounds) was assessed by the level of malonic dialdehyde. We also determined indicator of leukocyte chemiluminescence intensity (both basal and zymosan-stimulated). For assessment of the cardiovascular system functional state before and after chemotherapy we used electrocardiography (ECG), echocardiography (EchoCG) and 24-hour ECG monitoring. RESULTS The data obtained were indicative of increased generation of free radicals by leukocytes during polychemotherapy. After chemotherapy course we detected various types of cardiotoxicity. We noted substantial elevation of frequency of supraventricular and ventricular extrasystoles. There was direct correlation between rate of appearance of supraventricular extrasystoles and level of chemiluminescence of leukocytes (r=0.7; p=0.03). According to data of EchoCG although the left ventricular ejection fraction remained within the normal range during chemotherapy, there was a persistent tendency to its decrease (р<0.001). CONCLUSION In this study we for the first time in patients with Non-Hodgkin lymphomas detected an elevation of level of free radical reactions and lipid peroxidation with simultaneous lowering of antiperoxidative activity of blood plasma and their relation to development of cardiotoxic effects. The results obtained indicate to necessity of search for novel early markers of oxidative stress activation, myocardial injury and disfunction able to help to substantially decrease risk of development of cardiovascular complications during and after chemotherapy.
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Affiliation(s)
- Yu N Belenkov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V I Ershov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O N Antyufeeva
- Sechenov First Moscow State Medical University (Sechenov University)
| | - D A Budanova
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - I Yu Gadaev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O V Bochkarnikova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I Ya Sokolova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - Yu Yu Kirichenko
- Sechenov First Moscow State Medical University (Sechenov University)
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19
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Abstract
PURPOSE OF REVIEW Rituximab-based chemoimmunotherapy has resulted in a marked improvement in the survival of diffuse large B cell lymphoma (DLBCL). We reflect upon the history front-line (1L) therapy and highlight advances in management. RECENT FINDINGS Since the introduction of R-CHOP, the majority of randomized studies in the front-line treatment of DLBCL have failed to show a benefit. Such studies have involved treatment intensification, adding novel agents to the R-CHOP backbone and targeting such novel agents to biologically defined subgroups. R-CHOP therefore remains standard-of-care for most but new insights into the molecular biology of these diseases, and the development of active targeted molecules offers promise for the future. Accumulating evidence in the very elderly suggests dose attenuation does not compromise survival. Intensification in primary mediastinal B cell lymphoma may avoid the need for radiotherapy, but must be balanced against the risks. PET-CT- and ctDNA-based response assessment may now enable response adapted therapy and early prognostication, improving patient selection and potentially outcomes. Novel technologies and therapies in combination with novel molecular diagnostics will likely become the standard-of-care approach for the personalized therapy of DLBCL but need to be proven in well-designed and conducted randomized trials.
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Affiliation(s)
- Murali Kesavan
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE UK
- University of Oxford Department of Oncology Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Toby A. Eyre
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE UK
- University of Oxford Department of Oncology Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Graham P. Collins
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE UK
- University of Oxford Department of Oncology Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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20
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Staab J, Cotter E, Kidd B, Wallisch WJ, Flynn BC. Review and Update: Hematologic Malignancies and Adult Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 34:759-771. [PMID: 31447276 DOI: 10.1053/j.jvca.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 01/02/2023]
Abstract
As treatments for hematologic malignancies continue to advance, many patients with active disease and many more in remission will present for cardiac surgical procedures. Radiation and chemotherapeutic therapies for hematologic malignancies often result in cardiopulmonary injury. Evidence demonstrates that patients with hematologic malignancies undergoing cardiac surgery are at risk for perioperative adverse events, including bleeding, clotting, infection, and immunomodulation. However, short- and long-term mortality has been found to be acceptable. This review will distinguish the important points of characterizing, understanding, and managing hematologic malignancies in the cardiac surgical patient.
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Affiliation(s)
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- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - Jared Staab
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - Elizabeth Cotter
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - Brent Kidd
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - William J Wallisch
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - Brigid C Flynn
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.
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21
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Abuamsha H, Kadri AN, Hernandez AV. Cardiovascular mortality among patients with non-Hodgkin lymphoma: Differences according to lymphoma subtype. Hematol Oncol 2019; 37:261-269. [PMID: 30916804 DOI: 10.1002/hon.2607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/01/2019] [Accepted: 03/16/2019] [Indexed: 11/06/2022]
Abstract
Survival rates of patients with non-Hodgkin lymphoma (NHL) have improved over the last decade. However, cardiotoxicities remain important adverse consequences of treatment with chemotherapy and radiation, although the burden of cardiovascular mortality (CVM) in such patients remains unknown. We conducted a retrospective cohort study of patients greater than or equal to 20 years of age diagnosed with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) between 2000 and 2013 using data extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. Our primary endpoint was CVM. The association between NHL and CVM was evaluated using multivariable Cox regression analysis after adjusting for other patient characteristics. We calculated standardized mortality ratios (SMRs) for CVM, comparing NHL patients with the general population. We identified 153 983 patients who met the inclusion criteria (69 329 with DLBCL, 48 650 with CLL/SLL, and 36 004 with FL). The median follow-up was 37 months (interquartile range, 10-78 months); the mean patient age was 66.24 (±14.69) years; 84 924 (55.2%) were men; 134 720 (87.5%) were White, and 131 912 (85.7%) did not receive radiation therapy. Overall, 9017 patients (5.8%) died from cardiovascular disease, and we found that NHL patients had a higher risk of CVM than the general population, after adjusting for age (SMR 15.2, 95% confidence interval: 14.89-15.52). The rates of CVM were 5.1%, 8%, and 4.4% in patients with DLBCL, CLL/SLL, and FL, respectively. Furthermore, across all NHL subtypes, older age, higher stage at the time of diagnosis (particularly stage 4), male sex, and living in the south were associated with higher risks of CVM. Our data suggest that risk assessment and careful cardiac monitoring are recommended for NHL patients, particularly those with the CLL/SLL subtypes.
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Affiliation(s)
- Hasan Abuamsha
- Department of Medicine, St. Vincent Charity Medical Center - Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Amer N Kadri
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-based Practice Center, Hartford, Connecticut, United States of America.,School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
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Kibudde S, Mondo CK, Kibirige D, Walusansa V, Orem J. Anthracycline induced cardiotoxicity in adult cancer patients: a prospective cohort study from a specialized oncology treatment centre in Uganda. Afr Health Sci 2019; 19:1647-1656. [PMID: 31148994 PMCID: PMC6531975 DOI: 10.4314/ahs.v19i1.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine the cumulative incidence of anthracycline induced cardiotoxicity (AIC), its predictors, and associated electrocardiographic and echocardiographic manifestations in adult cancer patients at Uganda Cancer Institute (UCI). METHODS We enrolled 160 participants between June 2013 and April 2014 and followed them up for a median of 146 days. Data on clinical, electrocardiographic and echocardiographic findings was obtained at baseline, and at completion of chemotherapy. The Pearson chi square test was used to identify the predictors associated with cardiotoxicity. RESULTS Of the 64 patients who were accessible for follow-up electrocardiography (ECG) and echocardiography (ECHO), fourteen participants developed cardiotoxicity hence a cumulative incidence rate of 21.9% with 95% CI 13.5%-33.43%. The predictors of AIC were female gender (p=0.025), LVEF (p=0.014) and LVFS (P=0.019). Anthracycline therapy was associated with shortening of the QRS duration (84.3±7.9 Vs 82.1±11.8 ms, p=0.005), prolongation of the QTc interval (411.9±30.7 Vs 447.2±39.4 ms, p=<0.001) and reduction in the LVEF (66.4±7.7 Vs 63.9±8.4%, p=0.026) and LVFS (36.9±6.2 Vs 35.1±6.6%, p=0.03). CONCLUSION The cumulative incidence of AIC in this study cohort was high. Our findings emphasize the need for early monitoring for AIC.
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Affiliation(s)
| | | | | | | | - Jackson Orem
- Uganda Cancer Institute, Department of Medical Oncology
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Lugtenburg PJ, Lyon AR, Marks R, Luminari S. Treatment of aggressive non-Hodgkin's lymphoma in frail patients: cardiac comorbidities and advanced age. Future Oncol 2019; 15:1197-1205. [PMID: 30730219 DOI: 10.2217/fon-2019-0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The decisive factor in selecting a treatment regimen for a frail patient with aggressive non-Hodgkin's lymphoma is identifying whether a patient is fit enough to tolerate curative-intent anthracycline-containing regimens or too frail and therefore at risk of being undertreated. As cardiac comorbidities are an important contributor to both the health status and the selection of treatment, cardiovascular profiling and baseline risk stratification prior to treatment should be considered. Comprehensive geriatric assessment is an efficient means of identifying elderly patients with non-Hodgkin's lymphoma who may benefit from a curative treatment approach. If anthracycline-based therapy is not suitable, alternative treatment options are available in frail patients with cardiac comorbidities, but these must be adjusted to the patient's health status to achieve a maximal benefit-risk ratio.
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Affiliation(s)
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton & Harefield NHS Trust, London, UK.,Imperial College London, National Heart & Lung Institute, London, UK
| | - Reinhard Marks
- Department of Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine & Medical Centre, University of Freiburg, Freiburg, Germany
| | - Stefano Luminari
- Hematology, Azienda USL IRCCS Reggio Emilia, Italy.,CHIMOMO Department University of Modena & Reggio Emilia, Reggio Emilia, Italy
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24
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Ganatra S, Nohria A, Shah S, Groarke JD, Sharma A, Venesy D, Patten R, Gunturu K, Zarwan C, Neilan TG, Barac A, Hayek SS, Dani S, Solanki S, Mahmood SS, Lipshultz SE. Upfront dexrazoxane for the reduction of anthracycline-induced cardiotoxicity in adults with preexisting cardiomyopathy and cancer: a consecutive case series. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2019; 5:1. [PMID: 32154008 PMCID: PMC7048095 DOI: 10.1186/s40959-019-0036-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiotoxicity associated with anthracycline-based chemotherapies has limited their use in patients with preexisting cardiomyopathy or heart failure. Dexrazoxane protects against the cardiotoxic effects of anthracyclines, but in the USA and some European countries, its use had been restricted to adults with advanced breast cancer receiving a cumulative doxorubicin (an anthracycline) dose > 300 mg/m2. We evaluated the off-label use of dexrazoxane as a cardioprotectant in adult patients with preexisting cardiomyopathy, undergoing anthracycline chemotherapy. METHODS Between July 2015 and June 2017, five consecutive patients, with preexisting, asymptomatic, systolic left ventricular (LV) dysfunction who required anthracycline-based chemotherapy, were concomitantly treated with off-label dexrazoxane, administered 30 min before each anthracycline dose, regardless of cancer type or stage. Demographic, cardiovascular, and cancer-related outcomes were compared to those of three consecutive patients with asymptomatic cardiomyopathy treated earlier at the same hospital without dexrazoxane. RESULTS Mean age of the five dexrazoxane-treated patients and three patients treated without dexrazoxane was 70.6 and 72.6 years, respectively. All five dexrazoxane-treated patients successfully completed their planned chemotherapy (doxorubicin, 280 to 300 mg/m2). With dexrazoxane therapy, changes in LV systolic function were minimal with mean left ventricular ejection fraction (LVEF) decreasing from 39% at baseline to 34% after chemotherapy. None of the dexrazoxane-treated patients experienced symptomatic heart failure or elevated biomarkers (cardiac troponin I or brain natriuretic peptide). Of the three patients treated without dexrazoxane, two received doxorubicin (mean dose, 210 mg/m2), and one received daunorubicin (540 mg/m2). Anthracycline therapy resulted in a marked reduction in LVEF from 42.5% at baseline to 18%. All three developed symptomatic heart failure requiring hospitalization and intravenous diuretic therapy. Two of them died from cardiogenic shock and multi-organ failure. CONCLUSION The concomitant administration of dexrazoxane in patients with preexisting cardiomyopathy permitted successful delivery of anthracycline-based chemotherapy without cardiac decompensation. Larger prospective trials are warranted to examine the use of dexrazoxane as a cardioprotectant in patients with preexisting cardiomyopathy who require anthracyclines.
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Affiliation(s)
- Sarju Ganatra
- Cardio-Oncology Program, Lahey Hospital and Medical Center, Burlington, MA USA
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA USA
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Anju Nohria
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Sachin Shah
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA USA
| | - John D. Groarke
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Ajay Sharma
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA USA
| | - David Venesy
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA USA
| | - Richard Patten
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA USA
| | - Krishna Gunturu
- Department of Hematology Oncology, Lahey Hospital and Medical Center, Burlington, MA USA
- Cancer Survivorship Program, Lahey Hospital and Medical Center, Burlington, MA USA
| | - Corrine Zarwan
- Department of Hematology Oncology, Lahey Hospital and Medical Center, Burlington, MA USA
| | - Tomas G. Neilan
- Cardio-Oncology Program, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
| | - Ana Barac
- Cardio-Oncology Program, Division of Cardiology, Medstar Washington Hospital Center, Washington, DC USA
| | - Salim S. Hayek
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI USA
| | - Sourbha Dani
- Division of Cardiovascular Medicine, Eastern Maine Medical Center, Bangor, ME USA
| | - Shantanu Solanki
- Department of Medicine, Westchester Medical Center, Valhalla, NY USA
| | - Syed Saad Mahmood
- Division of Cardiovascular Medicine, New-York Presbyterian Hospital/Weill Cornell Medical Center, New York City, NY USA
| | - Steven E. Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Oishei Children’s Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
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25
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Prusila REI, Peroja P, Jantunen E, Turpeenniemi-Hujanen T, Kuittinen O. Treatment of diffuse large B-cell lymphoma in elderly patients: Replacing doxorubicin with either epirubicin or etoposide (VP-16). Hematol Oncol 2019; 37:136-142. [PMID: 30589950 DOI: 10.1002/hon.2572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Roosa Enni Inkeri Prusila
- Cancer and Translational Medicine Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Pekka Peroja
- Cancer and Translational Medicine Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Esa Jantunen
- Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Siunsote - Hospital District of North Carelia, Joensuu, Finland
| | - Taina Turpeenniemi-Hujanen
- Cancer and Translational Medicine Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Outi Kuittinen
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland.,Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Oncology, Kuopio University Hospital, Kuopio, Finland
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26
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Evsina OV, Seliverstova DV. [Not Available]. KARDIOLOGIIA 2018; 58:4-13. [PMID: 30625085 DOI: 10.18087/cardio.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
Patients with cancer have high risk of cardiovascular complications. They may be caused by tumor and cancer therapy. The possible approaches to the prevention of cardiotoxicity are discussed in this article: risk factors assessment, laboratory and instrumental diagnostics, non-pharmacological and pharmacological interventions.
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27
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Iqubal A, Iqubal MK, Sharma S, Ansari MA, Najmi AK, Ali SM, Ali J, Haque SE. Molecular mechanism involved in cyclophosphamide-induced cardiotoxicity: Old drug with a new vision. Life Sci 2018; 218:112-131. [PMID: 30552952 DOI: 10.1016/j.lfs.2018.12.018] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 12/20/2022]
Abstract
Cyclophosphamide (CP) is an important anticancer drug which belongs to the class of alkylating agent. Cyclophosphamide is mostly used in bone marrow transplantation, rheumatoid arthritis, lupus erythematosus, multiple sclerosis, neuroblastoma and other types of cancer. Dose-related cardiotoxicity is a limiting factor for its use. CP-induced cardiotoxicity ranges from 7 to 28% and mortality ranges from 11 to 43% at the therapeutic dose of 170-180 mg/kg, i.v. CP undergoes hepatic metabolism that results in the production of aldophosphamide. Aldophosphamide decomposes into phosphoramide mustard & acrolein. Phosphoramide is an active neoplastic agent, and acrolein is a toxic metabolite which acts on the myocardium and endothelial cells. This is the first review article that talks about cyclophosphamide-induced cardiotoxicity and the different signaling pathways involved in its pathogenicity. Based on the available literature, CP is accountable for cardiomyocytes energy pool alteration by affecting the heart fatty acid binding proteins (H-FABP). CP has been found associated with cardiomyocytes apoptosis, inflammation, endothelial dysfunction, calcium dysregulation, endoplasmic reticulum damage, and mitochondrial damage. Molecular mechanism of cardiotoxicity has been discussed in detail through crosstalk of Nrf2/ARE, Akt/GSK-3β/NFAT/calcineurin, p53/p38MAPK, NF-kB/TLR-4, and Phospholamban/SERCA-2a signaling pathway. Based on the available literature we support the fact that metabolites of CP are responsible for cardiotoxicity due to depletion of antioxidants/ATP level, altered contractility, damaged endothelium and enhanced pro-inflammatory/pro-apoptotic activities resulting into cardiomyopathy, myocardial infarction, and heart failure. Dose adjustment, elimination/excretion of acrolein and maintenance of endogenous antioxidant pool could be the therapeutic approach to mitigate the toxicities.
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Affiliation(s)
- Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Sumit Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Mohd Asif Ansari
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Abul Kalam Najmi
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Syed Mansoor Ali
- Department of Biosciences, Jamia Millia Islamia,110025 New Delhi, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Syed Ehtaishamul Haque
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
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28
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Late Complications of Hematologic Diseases and Their Therapies. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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29
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Abstract
The number of cancer survivors increases annually, because of advances in detection and treatment, and the aging and growth of the population. This increase has brought a concomitant increase in morbidity and mortality from other conditions related to the adverse effects of cancer treatments. Cardiovascular diseases, and in particular left ventricular dysfunction and heart failure, are among the most significant of these. There are no unified and universally accepted evidence-based practice guidelines on the management of heartfailure in this population. This article discusses the epidemiologic impact of cancer therapeutics-related cardiac dysfunction, and reviews its most significant mediators and provides a condensed but comprehensive synopsis on its evaluation and management.
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Affiliation(s)
- Jose Emanuel Finet
- Krannert Institute of Cardiology, Indiana University, IU Health Methodist Hospital, 1801 North Senate Boulevard, MPC-2, Suite 2000, Indianapolis, IN 46202, USA.
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30
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Laursen AH, Thune JJ, Hutchings M, Hasbak P, Kjaer A, Elming MB, Ripa RS. 123
I-MIBG imaging for detection of anthracycline-induced cardiomyopathy. Clin Physiol Funct Imaging 2017; 38:176-185. [DOI: 10.1111/cpf.12419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Adam H. Laursen
- Department of Haematology; Rigshospitalet; Copenhagen Denmark
| | | | | | - Philip Hasbak
- Department of Clinical Physiology; Nuclear Medicine & PET and Cluster for Molecular Imaging; Rigshospitalet and University of Copenhagen; Copenhagen Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology; Nuclear Medicine & PET and Cluster for Molecular Imaging; Rigshospitalet and University of Copenhagen; Copenhagen Denmark
| | - Marie B. Elming
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Rasmus S. Ripa
- Department of Clinical Physiology; Nuclear Medicine & PET and Cluster for Molecular Imaging; Rigshospitalet and University of Copenhagen; Copenhagen Denmark
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31
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Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM, Zamorano JL, Aboyans V, Achenbach S, Agewall S, Badimon L, Barón‐Esquivias G, Baumgartner H, Bax JJ, Bueno H, Carerj S, Dean V, Erol Ç, Fitzsimons D, Gaemperli O, Kirchhof P, Kolh P, Lancellotti P, Lip GYH, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Roffi M, Torbicki A, Vaz Carneiro A, Windecker S, Achenbach S, Minotti G, Agewall S, Badimon L, Bueno H, Cardinale D, Carerj S, Curigliano G, de Azambuja E, Dent S, Erol C, Ewer MS, Farmakis D, Fietkau R, Fitzsimons D, Gaemperli O, Kirchhof P, Kohl P, McGale P, Ponikowski P, Ringwald J, Roffi M, Schulz‐Menger J, Stebbing J, Steiner RK, Szmit S, Vaz Carneiro A, Windecker S. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur J Heart Fail 2016; 19:9-42. [DOI: 10.1002/ejhf.654] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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32
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Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37:2768-2801. [DOI: 10.1093/eurheartj/ehw211] [Citation(s) in RCA: 1498] [Impact Index Per Article: 187.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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33
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Intra-patient Variability of FDG Standardized Uptake Values in Mediastinal Blood Pool, Liver, and Myocardium during R-CHOP Chemotherapy in Patients with Diffuse Large B-cell Lymphoma. Nucl Med Mol Imaging 2016; 50:300-307. [PMID: 27994685 DOI: 10.1007/s13139-016-0432-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/09/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE 18F-fluorodeoxyglucose (FDG) PET/CT is useful for staging and evaluating treatment response in patients with diffuse large B-cell lymphoma (DLBCL). A five-point scale model using the mediastinal blood pool (MBP) and liver as references is a recommended method for interpreting treatment response. We evaluated the variability in standardized uptake values (SUVs) of the MBP, liver, and myocardium during chemotherapy in patients with DLBCL. METHODS We analyzed 60 patients with DLBCL who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) treatment and underwent baseline, interim, and final FDG PET/CT scans. The FDG uptakes of lymphoma lesions, MBP, liver, and myocardium were assessed, and changes in the MBP and liver SUV and possible associated factors were evaluated. RESULTS The SUV of the liver did not change significantly during the chemotherapy. However, the SUVmean of MBP showed a significant change though the difference was small (p = 0.019). SUVmean of MBP and liver at baseline and interim scans was significantly lower in patients with advanced Ann Arbor stage on diagnosis. The SUVmean of the MBP and liver was negatively correlated with the volumetric index of lymphoma lesions in baseline scans (r = -0.547, p < 0.001; r = -0.502, p < 0.001). Positive myocardial FDG uptake was more frequently observed in interim and final scans than in the baseline scan, but there was no significant association between the MBP and liver uptake and myocardial uptake. CONCLUSIONS The SUV of the liver was not significantly changed during R-CHOP chemotherapy in patients with DLBCL, whereas the MBP SUV of the interim scan decreased slightly. However, the SUV of the reference organs may be affected by tumor burden, and this should be considered when assessing follow-up scans. Although myocardial FDG uptake was more frequently observed after R-CHOP chemotherapy, it did not affect the SUV of the MBP and liver.
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Oliveira GH, Al-Kindi SG, Caimi PF, Lazarus HM. Maximizing anthracycline tolerability in hematologic malignancies: Treat to each heart's content. Blood Rev 2016; 30:169-78. [DOI: 10.1016/j.blre.2015.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/20/2015] [Accepted: 11/02/2015] [Indexed: 01/01/2023]
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35
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Baldeo C, Hritani A, Baldeo C, Percy R. Does chemo-radiation predispose to structural valve deterioration? Int J Cardiol 2016; 211:53-4. [PMID: 26974696 DOI: 10.1016/j.ijcard.2016.02.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Candice Baldeo
- University of Florida - Jacksonville, Internal Medicine Department, United States.
| | - AbdulWahab Hritani
- University of Florida - Jacksonville, Internal Medicine Department, United States
| | | | - Robert Percy
- University of Florida - Jacksonville, Department of Cardiology, United States
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Abstract
The identification of patients at risk of cardiac toxicity (cardiotoxicity) from cancer therapy is challenging. There is an increasing focus on early detection of cardiotoxicity such that interventions can be instituted to prevent advanced heart failure. Clinical risk prediction tools are limited and clinical symptoms are not specific. Direct assessment of myocardial function before and during cancer treatment using cardiac imaging appears to be an objective method to identify patients at risk. Although, multiple imaging modalities and measures of cardiac function are available, the best modality or the optimal measure of function is unknown. Measurement of left ventricular ejection fraction is most commonly used; however, growing literature suggests that it is inadequate for the detection of early cardiac injury. Other measures include left ventricular diastolic function, myocardial deformation, and myocardial tissue characterization. This review will provide an overview of the clinically available measures for the assessment of cardiotoxicity.
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37
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Boyle EM, Morschhauser F. Pixantrone: a novel anthracycline-like drug for the treatment of non-Hodgkin lymphoma. Expert Opin Drug Saf 2015; 14:601-7. [DOI: 10.1517/14740338.2015.1010505] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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38
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Edwardson DW, Narendrula R, Chewchuk S, Mispel-Beyer K, Mapletoft JPJ, Parissenti AM. Role of Drug Metabolism in the Cytotoxicity and Clinical Efficacy of Anthracyclines. Curr Drug Metab 2015; 16:412-26. [PMID: 26321196 PMCID: PMC5398089 DOI: 10.2174/1389200216888150915112039] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/31/2015] [Accepted: 08/10/2015] [Indexed: 01/19/2023]
Abstract
Many clinical studies involving anti-tumor agents neglect to consider how these agents are metabolized within the host and whether the creation of specific metabolites alters drug therapeutic properties or toxic side effects. However, this is not the case for the anthracycline class of chemotherapy drugs. This review describes the various enzymes involved in the one electron (semi-quinone) or two electron (hydroxylation) reduction of anthracyclines, or in their reductive deglycosidation into deoxyaglycones. The effects of these reductions on drug antitumor efficacy and toxic side effects are also discussed. Current evidence suggests that the one electron reduction of anthracyclines augments both their tumor toxicity and their toxicity towards the host, in particular their cardiotoxicity. In contrast, the two electron reduction (hydroxylation) of anthracyclines strongly reduces their ability to kill tumor cells, while augmenting cardiotoxicity through their accumulation within cardiomyocytes and their direct effects on excitation/contraction coupling within the myocytes. The reductive deglycosidation of anthracyclines appears to inactivate the drug and only occurs under rare, anaerobic conditions. This knowledge has resulted in the identification of important new approaches to improve the therapeutic index of anthracyclines, in particular by inhibiting their cardiotoxicity. The true utility of these approaches in the management of cancer patients undergoing anthracycline-based chemotherapy remains unclear, although one such agent (the iron chelator dexrazoxane) has recently been approved for clinical use.
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Affiliation(s)
| | | | | | | | | | - Amadeo M Parissenti
- Dept. of Chemistry and Biochemistry, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada.
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Pre-existing arterial hypertension as a risk factor for early left ventricular systolic dysfunction following (R)-CHOP chemotherapy in patients with lymphoma. ACTA ACUST UNITED AC 2014; 8:791-9. [PMID: 25455004 DOI: 10.1016/j.jash.2014.08.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/31/2014] [Accepted: 08/13/2014] [Indexed: 12/21/2022]
Abstract
Experimental studies in animals suggest that arterial hypertension may be a specific risk factor predisposing to anthracycline cardiotoxicity. The aim was determination of the effect of pre-existing arterial hypertension on the development of early left ventricular systolic dysfunction (LVSD) directly after rituximab, cyclophosphamide, doxorubicin, vincristin, prednisone ([R]-CHOP) chemotherapy in patients with lymphomas.The study included 208 patients with non-Hodgkin's lymphoma receiving conventional doxorubicin. LVSD was defined as a decrease of left ventricular ejection fraction below 50% and at least by 10 percentage points from baseline value. Patients with pre-existing hypertension more frequently developed new LVSD (19.7% vs. 6.6%; P = .004), pitting edema of the ankles (23.9% vs. 9.5%; P = .005), and nycturia (21.1% vs. 7.3%; P = .004) compared with patients without hypertension. As a consequence, the hypertension subgroup suffered from more delays of subsequent chemotherapy cycles (26.8% vs. 14.6%; P = .03), more reductions of doxorubicin doses (18.3% vs. 8.8%; P = .05), and premature discontinuations of chemotherapy (16.9% vs. 7.3%; P = .03). On logistic regression analyses, hypertension was one of the most important risk factors for developing new LVSD after (R)-CHOP chemotherapy.Arterial hypertension confers a significant risk of early LVSD in lymphoma patients treated with (R)-CHOP chemotherapy, interfering with its recommended schedule of administration.
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