Incidence, Clinical Characteristics and Outcome of Cardiac Toxicity in Elderly Patients with Diffuse Large B-Cell Lymphoma

Backgroud:

Cardiac toxicity is a life-threatening complication in elderly patients with lymphoma, which lead to a delay or premature termination of chemotherapy.

Methods:

A total of 462 consecutive patients with diffuse large B-cell lymphoma over 60 years old between 2007 and 2017 were reviewed. Of these, 87 patients were excluded from the study. Finally, 375 lymphoma patients were included. Data about general information, clinical feature, laboratory examination, pathological results, therapeutic methods and cardiac toxicity were collected by case retrieval system. Cardiac toxicity was graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE).

Results:

The incidence of cardiac disorders was 5.3% (20/375). The median number of chemotherapy cycles before cardiac toxicity was 1 (range, 1-4). Ventricular arrhythmia was the most frequent cardiac disorder (n=6), followed by palpitations (n=4), left ventricular systolic dysfunction (n=3), heart failure (n=3), atrial fibrillation (n=2), myocardial infarction (n=1) and paroxysmal atrial tachycardia (n=1). At the end of treatment, grades 3 to 5 cardiac events were observed in 8 patients. In a multivariate Cox regression analysis, ECOG performance status ≥2 and history of cardiovascular disease were identified as risk factors for IP. The cumulative incidence of cardiac disorders were 2.3% (6/266) for patients without risk factors, 11.6% (11/95) for patients with 1 risk factors, and 21.4% (3/14), respectively.

Conclusion:

Cardiac toxicity is not rare in elderly patients with lymphoma, and a comprehensive management strategy is needed.