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Anthracycline‐induced cardiotoxicity in diffuse large B‐cell lymphoma: NT‐proBNP and cardiovascular score for risk stratification
Author(s) -
Ferraro Mariana Paola,
GimenoVazquez Eva,
Subirana Isaac,
Gómez Miquel,
Díaz Javier,
SánchezGonzález Blanca,
GarcíaPallarols Francesc,
Martínez Laia,
Ble Mireia,
Molina Lluis,
Belarte Laia Carla,
Abella Eugenia,
Elosua Roberto,
ComínColet Josep,
Salar Antonio
Publication year - 2019
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13234
Subject(s) - risk stratification , cardiotoxicity , anthracycline , medicine , diffuse large b cell lymphoma , cardiology , lymphoma , toxicity , cancer , breast cancer
Abstract Objective To evaluate the role of N‐terminal pro‐brain‐type natriuretic peptide (NT‐proBNP) and a cardiovascular (CV) risk score named FRESCO for predicting anthracycline‐induced cardiotoxicity (AIC) in diffuse large B‐cell lymphoma (DLBCL). Methods A total of 130 consecutive DLBCL patients treated in first‐line with anthracycline‐containing immunochemotherapy. Competitive risk between NT‐proBNP, FRESCO, and time to AIC was considered. Results Cumulative incidence of AIC was 12.2% and 17.5% at 1 and 5 years, respectively. Median time to development cardiotoxicity was 6.4 months, with half of the cases showing heart failure and the other half silent AIC. Both NT‐proBNP levels and FRESCO score were independently associated with higher risk of AIC ( P = 0.001 and P = 0.03, respectively). Patients with NT‐proBNP ≥600 pg/mL or those with FRESCO ≥4.5% had 3.97 or 2.54 times higher risk of AIC than those with lower values ( P = 0.001 and P = 0.048, respectively). According to the previous cutoffs, three groups of patients with a significantly different risk of AIC could be identified ( P < 0.0001). Conclusions Doxorubicin‐containing chemotherapy is associated with increased risk of silent and overt AIC. Baseline NT‐proBNP levels and FRESCO CV risk score are accurate predictors of AIC and can identify groups of patients at different risk, in which personalized cardiologic evaluation should be offered.