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Bisceglia I, Canale ML, Silvestris N, Gallucci G, Camerini A, Inno A, Camilli M, Turazza FM, Russo G, Paccone A, Mistrulli R, De Luca L, Di Fusco SA, Tarantini L, Lucà F, Oliva S, Moreo A, Maurea N, Quagliariello V, Ricciardi GR, Lestuzzi C, Fiscella D, Parrini I, Racanelli V, Russo A, Incorvaia L, Calabrò F, Curigliano G, Cinieri S, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. Cancer survivorship at heart: a multidisciplinary cardio-oncology roadmap for healthcare professionals. Front Cardiovasc Med 2023; 10:1223660. [PMID: 37786510 PMCID: PMC10541962 DOI: 10.3389/fcvm.2023.1223660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
In cancer, a patient is considered a survivor from the time of initial diagnosis until the end of life. With improvements in early diagnosis and treatment, the number of cancer survivors (CS) has grown considerably and includes: (1) Patients cured and free from cancer who may be at risk of late-onset cancer therapy-related cardiovascular toxicity (CTR-CVT); (2) Patients with long-term control of not-curable cancers in whom CTR-CVT may need to be addressed. This paper highlights the importance of the cancer care continuum, of a patient-centered approach and of a prevention-oriented policy. The ultimate goal is a personalized care of CS, achievable only through a multidisciplinary-guided survivorship care plan, one that replaces the fragmented management of current healthcare systems. Collaboration between oncologists and cardiologists is the pillar of a framework in which primary care providers and other specialists must be engaged and in which familial, social and environmental factors are also taken into account.
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Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Maria Laura Canale
- Division of Cardiology, Ospedale Versilia, Azienda Usl Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Nicola Silvestris
- Unit of Medical Oncology, Department of Human Pathology in Adulthood and Childhood Gaetano Barresi, University of Messina, Messina, Italy
| | - Giuseppina Gallucci
- Cardio-oncology Unit, Department of OncoHaematology, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Andrea Camerini
- Department of Medical Oncology, Ospedale Versilia, Azienda Usl Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Alessandro Inno
- Department of Oncology, Sacro Cuore Don Calabria Hospital (IRCCS), Negrar, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Maria Turazza
- Cardiology Department, National Cancer Institute Foundation (IRCCS), Milan, Italy
| | - Giulia Russo
- SC Patologie Cardiovascolari, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Andrea Paccone
- Department of Cardiology, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Raffaella Mistrulli
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Lazio, Italy
| | - Leonardo De Luca
- Division of Cardiology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Luigi Tarantini
- Divisione di Cardiologia, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio-Emilia, Reggio Emilia, Italy
| | - Fabiana Lucà
- Cardiologia Interventistica, Utic, Grande Ospedale Metropolitano, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Stefano Oliva
- UOSD Cardiologia di Interesse Oncologico, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonella Moreo
- Cardio Center De Gasperis, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicola Maurea
- Department of Cardiology, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Vincenzo Quagliariello
- Department of Cardiology, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | | | | | - Damiana Fiscella
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Iris Parrini
- Department of Cardiology, Hospital Mauritian Turin, Turin, Italy
| | - Vito Racanelli
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital, Palermo, Italy
| | - Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital, Palermo, Italy
| | - Fabio Calabrò
- Department of Oncology and Specialized Medicine, San Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Domenico Gabrielli
- Division of Cardiology, San Camillo-Forlanini Hospital, Rome, Italy
- Fondazione per il Tuo cuore- Heart Care Foundation, Firenze, Italy
| | - Fabrizio Oliva
- Cardiologia 1- Emodinamica, Dipartimento Cardiotoracovascolare “A. De Gasperis”, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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Juul MB, Jelicic J, Anru PL, Engberg H, Hammershøj Jensen P, Kristensen HB, Baech J, Clausen MR, Gang AO, Munksgaard L, El-Galaly TC, Frederiksen H, Stauffer Larsen T. Cardiovascular diseases in elderly survivors of diffuse large B-cell lymphoma: a Danish population-based cohort study. Leuk Lymphoma 2022; 63:2074-2083. [DOI: 10.1080/10428194.2022.2064982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maja Bech Juul
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
| | - Jelena Jelicic
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Hematology, Vejle Sygehus, Vejle, Denmark
| | - Pavithra Laxsen Anru
- Department of Clinical Research, Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Henriette Engberg
- Department of Clinical Research, Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | | | - Joachim Baech
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Roost Clausen
- Department of Hematology, Vejle Sygehus, Vejle, Denmark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Munksgaard
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
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Lee SF, Vellayappan BA, Wong LC, Chiang CL, Chan SK, Wan EYF, Wong ICK, Lambert PC, Rachet B, Ng AK, Luque-Fernandez MA. Cardiovascular diseases among diffuse large B-cell lymphoma long-term survivors in Asia: a multistate model study. ESMO Open 2022; 7:100363. [PMID: 35026723 PMCID: PMC8760397 DOI: 10.1016/j.esmoop.2021.100363] [Citation(s) in RCA: 2] [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] [Received: 10/02/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We modeled the clinical course of a cohort of diffuse large B-cell lymphoma (DLBCL) patients with no prior cardiovascular diseases (CVDs) using a multistate modeling framework. PATIENTS AND METHODS Data on 2600 patients with DLBCL diagnosed between 2000 and 2018 and had received chemotherapy with or without radiotherapy were obtained from a population-wide electronic health database of Hong Kong. We used the Markov illness-death model to quantify the impact of doxorubicin and various risk factors (therapeutic exposure, demographic, comorbidities, cardiovascular risk factors, and lifestyle factors which included smoking) on the clinical course of DLBCL (transitions into incident CVD, lymphoma death, and other causes of death). RESULTS A total of 613 (23.6%) and 230 (8.8%) of 2600 subjects died of lymphoma and developed incident CVD, respectively. Median follow-up was 7.0 years (interquartile range 3.8-10.8 years). Older ages [hazard ratio (HR) for >75 versus ≤60 years 1.88; 95% confidence interval (CI) 1.25-2.82 and HR for 61-75 versus ≤60 years 1.60; 95% CI 1.12-2.30], hypertension (HR 4.92; 95% CI 2.61-9.26), diabetes (HR 1.43; 95% CI 1.09-1.87), and baseline use of aspirin (HR 5.30; 95% CI 3.93-7.16) were associated with an increased risk of incident CVD. In a subgroup of anticipated higher-risk patients (aged 61-75 years, smoked, had diabetes, and received doxorubicin), we found that they remained on average 7.9 (95% CI 7.2-8.8) years in the DLBCL state and 0.1 (95% CI 0.0-0.4) years in the CVD state, if they could be followed up for 10 years. The brief time in the CVD state is consistent with the high chance of death in patients who developed CVD. Other causes of death have overtaken DLBCL-related death after about 5 years. CONCLUSIONS In this Asian population-based cohort, we found that incident CVDs can occur soon after DLBCL treatment and continued to occur throughout survivorship. Clinicians are advised to balance the risks and benefits of treatment choices to minimize the risk of CVD.
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Affiliation(s)
- S F Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - B A Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - L C Wong
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - C L Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - S K Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - E Y-F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong
| | - I C-K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong; Research Department of Policy and Practice, School of Pharmacy, University College London, London, UK
| | - P C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - B Rachet
- Department of Non-Communicable Disease Epidemiology, ICON Group, London School of Hygiene and Tropical Medicine, London, UK
| | - A K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M A Luque-Fernandez
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), Andalusian School of Public Health, Granada, Spain.
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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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5
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Landgren O. Cure with heart in mind! J Intern Med 2021; 290:947-948. [PMID: 34110046 DOI: 10.1111/joim.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Affiliation(s)
- O Landgren
- From the, Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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Doxorubicin and subsequent risk of cardiovascular diseases among survivors of diffuse large B-cell lymphoma in Hong Kong. Blood Adv 2021; 4:5107-5117. [PMID: 33085755 DOI: 10.1182/bloodadvances.2020002737] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/09/2020] [Indexed: 02/01/2023] Open
Abstract
Evidence regarding the dose-related impact of doxorubicin on subsequent cardiovascular diseases (CVDs) in Asian patients with diffuse large B-cell lymphoma (DLBCL) without preexisting CVDs is lacking. From a territory-wide electronic database in Hong Kong, we identified adults who were diagnosed with DLBCL and treated with chemotherapy between 2000 and 2018. We evaluated the patients for incident CVDs (including ischemic heart disease, heart failure, and cardiomyopathy). We evaluated the cause-specific cumulative incidence (csCI) of CVD with levels of doxorubicin exposure by using flexible parametric competing risk analysis and adjusting for demographics, comorbidities, therapeutic exposure, cardiovascular risk factors, and lifestyle factors. Controls were age- and sex-matched to DLBCL patients. We analyzed 2600 patients and 13 000 controls. The adjusted cause-specific hazard ratio (HR) for CVD in patients treated with >500 mg doxorubicin compared with non-doxorubicin regimens was 2.65 (95% confidence interval [CI], 1.23-5.74; P = .013). The 5-, 10-, and 15-year csCIs were 8.2%, 11.3%, and 12.8% in patients vs 3.1%, 4.4%, and 5.2% in controls, respectively. Hypertension (HR, 6.20; 95% CI, 0.79-48.44; P = .082) and use of aspirin/angiotensin-converting enzyme inhibitor/beta-blocker at baseline (HR, 2.13-4.63; P < .001 to .002) might confer a higher risk of subsequent CVDs. In this Hong Kong population-based study, doxorubicin exposure (absolute dose >500 mg), together with hypertension or baseline use of medication for cardiovascular risk factors, was found to be associated with an increase in csCIs of CVDs. Tailoring therapeutic strategies to underlying CVD risk factors and risk-adapted monitoring and follow-up of susceptible DLBCL patients are advisable.
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Kenzik KM, Mehta A, Richman JS, Kilgore M, Bhatia S. Congestive heart failure in older adults diagnosed with follicular lymphoma: A population-based study. Cancer 2018; 124:4221-4230. [DOI: 10.1002/cncr.31695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly M. Kenzik
- Institute for Cancer Outcomes and Survivorship; University of Alabama at Birmingham; Birmingham Alabama
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama
| | - Amitkumar Mehta
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama
| | - Joshua S. Richman
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Meredith Kilgore
- Department of Health Care Organization and Policy; University of Alabama at Birmingham; Birmingham Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship; University of Alabama at Birmingham; Birmingham Alabama
- Division of Pediatric Hematology Oncology; University of Alabama at Birmingham; Birmingham Alabama
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Howlader N, Mariotto AB, Besson C, Suneja G, Robien K, Younes N, Engels EA. Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era. Cancer 2017; 123:3326-3334. [DOI: 10.1002/cncr.30739] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Angela B. Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
| | - Caroline Besson
- Faculty of Medicine; University of Paris Sud; Le Kremlin-Bicêtre France
| | - Gita Suneja
- Department of Radiation Oncology; University of Utah; Salt Lake City Utah
| | - Kim Robien
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Naji Younes
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
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Ricciuti G, Finolezzi E, Luciani S, Ranucci E, Federico M, Di Nicola M, Zecca IAL, Angrilli F. Combination of rituximab and nonpegylated liposomal doxorubicin (R-NPLD) as front-line therapy for aggressive non-Hodgkin lymphoma (NHL) in patients 80 years of age or older: a single-center retrospective study. Hematol Oncol 2017; 36:44-48. [DOI: 10.1002/hon.2386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/28/2016] [Accepted: 01/08/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Giuseppina Ricciuti
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | - Erica Finolezzi
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | - Stefania Luciani
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | - Elena Ranucci
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | | | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences; “G. D'Annunzio” University; Chieti Italy
| | - Isaia Antonio Luca Zecca
- Department of Medical, Oral and Biotechnological Sciences; “G. D'Annunzio” University; Chieti Italy
| | - Francesco Angrilli
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
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10
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Clinical approach to diffuse large B cell lymphoma. Blood Rev 2016; 30:477-491. [PMID: 27596109 DOI: 10.1016/j.blre.2016.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 05/26/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common subtype of lymphoma. We now recognize that DLBCL corresponds to a biologically heterogeneous family of diseases. Given the potential for cure for most DLBCL patients, appropriate diagnostic and staging evaluation and therapy are essential. Here we review areas of consensus as well as controversy in the evaluation, treatment and monitoring of patients with DLBCL and its related subtypes.
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12
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Ha H, Keam B, Kim TM, Jeon YK, Lee SH, Kim DW, Kim CW, Heo DS. Reduced Dose Intensities of Doxorubicin in Elderly Patients with DLBCL in Rituximab Era. Cancer Res Treat 2015; 48:304-11. [PMID: 25865654 PMCID: PMC4720063 DOI: 10.4143/crt.2014.339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/11/2015] [Indexed: 12/22/2022] Open
Abstract
Purpose The dose intensity of doxorubicin (DID) is important to the survival of diffuse large B cell lymphoma (DLBCL) patients. However, due to expected toxicities, most elderly patients cannot receive full doses of anthracyclines. The purpose of this study was to evaluate the effect of DID on the survival of elderly DLBCL patients (age ≥ 70 years) in the rituximab era. Materials and Methods We analyzed 433 DLBCL patients who were treated with R-CHOP between December 2003 and October 2011 at the Seoul National University Hospital. Of these patients, 19.2% were aged ≥ 70 years. We analyzed the survival outcomes according to DID. Results Significantly poorer overall survival (OS) was observed for patients aged ≥ 70 years (2-year OS rate: 59.9% vs. 84.2%; p < 0.001). DID ≤ 10 mg/m2/wk had a significant effect on the OS and progression-free survival (PFS) in elderly patients (2-year OS rate: 40.0% in DID ≤ 10 mg/m2/wk vs. 62.6% in DID > 10 mg/m2/wk; p=0.031; 2-year PFS: 35.0% vs. 65.7%; p=0.036). The OS on each 1.7 mg/m2/wk doxorubicin increment above 10 mg/m2/wk in elderly patients was not significant among the groups (2-year OS rate: 75.0% in DID 10.0-11.7 mg/m2/wk vs. 66.7% in DID 15.0-16.7 mg/m2/wk; p=0.859). Treatment related mortality was not related to DID. Conclusion DID can be reduced up to 10 mg/m2/wk in elderly DLBCL patients in the rituximab era. Maintenance of DID > 10 mg/m2/wk and judicious selection of elderly patients who are tolerant to DID is necessary.
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Affiliation(s)
- Hyerim Ha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chul Woo Kim
- Department of Pathology, Seoul National University Hospital Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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