Late Cardiotoxicity of Intensive Modified Program NHL-BFM-90 in Adult Poor Prognosis Patients with Diffuse Large B-Cell Lymphoma

Aim. To evaluate late cardiotoxicity of intensive modified program NHL-BFM-90 (mNHL-BFM-90) in adult poor-prognosis patients with diffuse large B-cell lymphoma (DLBCL).

Materials and methods. The data of ECG and echocardiography of 40 patients DLBCL wich received mNHL-BFM-90 protocol in the Hematology Reserch Center in the period from 2002 to 2009 years was analyzed . Group consisted of 20 men, 20 women, aged from 31 to 76 years, median age - 56.5 years at the time of the survey, the median period after therapy- 6 years. Individual cumulative dose of doxorubicin - 150 to 300 mg / m². Comparison group included 19 patients, 8 men and 11 women, aged from 39 to 78 years, mediana- 70 years at the time of the survey, who received therapy to CHOP / R-CHOP. The median period after therapy - 5.5 years. Individual cumulative dose of doxorubicin - 200 - 400mg / m². ECG and echocardiography studies were performed before and after 5 or more years after the end of chemotherapy. Clinical cardiomyopathy was defined by the presence of clinical signs of congestive heart failure. Subclinical cardiomyopathy was defined by the presence of characteristic changes by echocardiography and ECG study without clinical signs of CHF.

Results. From 40 patients DLBCL wich received mNHL-BFM-90, signs of subclinical cardiomyopathy were detected in 24 (60%) patients, clinical heart failure was not defined in any patient. In comparison group signs of subclinical cardiomyopathy were detected in 14 (74%) patients. Clinical heart failure was not defined in any case. Summar index of cardiotoxicity was significantly dependent on age (p=0.03), the presence of cardiac disease in anamnesis (p=0.3), and significantly higher (p = 0.05) in the group of patients after CHOP / R-CHOP therapy. A risk of subclinical cardiomyopathy revealing was significantly higher in group with cardiac disease in anamnesis (p = 0.05).

Conclusion. Late cardiotoxicity of high-dose program mNHL-BFM 90 does not exceed the toxicity of standard CHOP / R-CHOP. Patients with ischemic heart disease, hypertension, diabetes in anamnesis had the most severe sings of subclinical cardiomyopathy after chemotherapy according to examination data. Clinically significant heart failure in any patient was identified.