Impact of cardiomyopathy and the correlation of cumulative anthacycline doseage. (A) Illustration of the impact of cardiomyopathy (decline in cardiac function) and/or heart failure before, during, or after anthracycline-based therapy in older patients with diffuse large B-cell lymphoma. ACR, anthracycline-containing regimen; R, rituxumab (modified from Tien et al,87 and based on data from Ammar et al.88 (B) Outline of the correlation of cumulative anthracycline dose (doxorubicin equivalent) and risk of heart failure and the impact of modulating factors such as cardiovascular risk factors (CVRFs), CVDs, and genetic predisposition, as well as lifestyle factors such as exercise/fitness and adjunctive/concomitant medications and therapies which shift the curve to the left (ie, increasing the likelihood of heart failure at a lower-dose spectrum) or to the right (ie, lower risk of heart failure at similar or even higher dose range).