Lymphoma survivors face increased risk for cardiac problems after HSCT
Left ventricular systolic dysfunction and heart failure occurred more frequently than previously reported in adult survivors of lymphoma who underwent autologous hematopoietic stem cell transplantation, according to study results.
Researchers identified several risk factors for left ventricular systolic dysfunction (LVSD) in this population, which could serve as a basis for targeted surveillance.
“Transplantation strategies and supportive care have evolved since the start of the HSCT era, resulting in improved survival,” Klaus Murbraech, MD, of the department of cardiology at Oslo University Hospital, and colleagues wrote. “Compared with age-matched controls, HSCT survivors have a close to threefold increased risk of cardiovascular complications, and cardiovascular diseases are the leading nonmalignant cause of death in this population.”
Murbraech and colleagues conducted a national cross-sectional study to assess the incidence of LVSD — including symptomatic heart failure and asymptomatic LVSD — in adult survivors of lymphoma who underwent autologous HSCT. The investigators also attempted to identify risk factors for LVSD in this population.
Murbraech and colleagues defined asymptomatic LVSD as left ventricular ejection fraction (LVEF) less than 50% by echocardiography, and they defined heart failure according to current practice recommendations.
All lymphoma survivors treated with autologous HSCT as adults in Norway between 1987 and 2008 were eligible. The analysis included data from 69% (n = 274) of eligible survivors (mean age, 56 ± 12 years; 62% men). Non-Hodgkin’s lymphoma served as primary disease for 78% of study patients.
The researchers compared data from adult survivors of lymphoma with an age- and sex-matched control group.
Mean follow-up from time of lymphoma diagnosis was 13 ± 6 years.
Patients received a mean cumulative doxorubicin dose of 316 ± 111 mg/m2. Ninety-seven participants (35%) received treatment with cardiac radiation therapy (median total dose, 29.75 Gy; range, 19-67).
Adult survivors of lymphoma faced a substantially increased risk for LVSD compared with controls (OR = 6.6; 95% CI, 2.5-17.6).
LVSD occurred in 15.7% (95% CI, 11-20) of adult survivors of lymphoma; of these, 5.1% were asymptomatic.
Severe heart failure — defined as New York Heart Association class III — occurred in 1.8% of patients; 8.8% of patients with heart failure were classified as New York Heart Association class II.
Patients with heart failure exhibited a median LVEF of 43% (range, 27-53), whereas patients with asymptomatic LVSD exhibited a median LVEF of 47% (range, 36-49).
Researchers determined a doxorubicin dose of greater than or equal to 300 mg/m2 (OR = 3.3; 95% CI, 1.2-8.9) and cardiac radiation therapy dose greater than 30 Gy (OR = 4.3; 95% CI, 1.7-11.4) served as independent risk factors for LVSD.
Murbraech and colleagues acknowledged the use of identical exclusion criteria among patients and controls may have led to an underestimation of the reported risk for LVSD among adult survivors of lymphoma.
“Our findings may help identify adult survivors of lymphoma at increased risk [for] LVSD after autologous HSCT and can serve as a basis for developing intensified surveillance strategies for these patients,” the researchers concluded. – by Cameron Kelsall
Disclosure: Murbraech reports no relevant financial disclosures. Other researchers report honoraria from Actelion Pharmaceuticals, Bayer and Pfizer; consultant roles with ResMed; and employment relationships with MI Lab.