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Heart Failure and Asymptomatic Left Ventricular Systolic Dysfunction in Lymphoma Survivors Treated With Autologous
Klaus Murbraech1, Knut B Smeland2, Harald Holte2
1Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway. sbmurk@ous-hf.no.
Insights
Left ventricular systolic dysfunction (LVSD) is common in lymphoma survivors after autologous stem-cell transplantation. Doxorubicin dose and cardiac radiation increase LVSD risk, necessitating targeted surveillance strategies for these patients.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Lymphoma survivors undergoing autologous hematopoietic stem-cell transplantation (auto-HCT) are at risk for long-term cardiac complications.
- Left ventricular systolic dysfunction (LVSD) and heart failure (HF) are known potential sequelae of cancer therapies, including chemotherapy and radiation.
Purpose of the Study:
- To determine the prevalence of LVSD, both symptomatic (HF) and asymptomatic, in adult lymphoma survivors (LSs) post-auto-HCT.
- To identify specific risk factors contributing to LVSD in this patient population.
Main Methods:
- A national cross-sectional study of adult LSs treated with auto-HCT in Norway (1987-2008).
- Echocardiography was used to define LVSD (ejection fraction <50%), and HF was classified per current guidelines.
- LSs were compared to an age- and sex-matched control group.
Main Results:
- LVSD was identified in 15.7% of LSs, with 5.1% being asymptomatic.
- Heart failure was present in 8.8% of LSs (NYHA class II), with rarer instances of severe HF (1.8%).
- LSs exhibited a significantly higher risk of LVSD compared to controls (OR, 6.6; P < .001).
- Independent risk factors for LVSD included doxorubicin dose ≥300 mg/m² and cardiac radiation dose >30 Gy.
Conclusions:
- LVSD and HF are more prevalent in LSs post-auto-HCT than previously reported.
- Identifying LSs at higher risk for LVSD is crucial.
- These findings support the development of targeted surveillance strategies for lymphoma survivors.
Purpose:
We aimed to determine the prevalence of left ventricular systolic dysfunction (LVSD), including symptomatic (ie, heart failure [HF]) and asymptomatic LVSD in adult lymphoma survivors (LSs) after autologous hematopoietic stem-cell transplantation (auto-HCT) and to identify risk factors for LVSD in this population.
Patients And Methods:
All LSs treated with auto-HCT as adults in Norway from 1987 to 2008 were eligible for this national cross-sectional study. Asymptomatic LVSD was defined as left ventricular ejection fraction less than 50% by echocardiography, and HF was defined according to current recommendations. The results in LSs were compared with those found in an age- and sex-matched (1:1) control group.
Results:
We examined 274 LSs (69% of all eligible survivors); 62% were men, the mean (± standard deviation) age was 56 ± 12 years, and mean follow-up time from lymphoma diagnosis was 13 ± 6 years. The mean cumulative doxorubicin dose was 316 ± 111 mg/m(2), and 35% of LSs had received additional radiation therapy involving the heart. We found LVSD in 15.7% of the LSs, of whom 5.1% were asymptomatic. HF patients were symptomatically mildly affected, with 8.8% of all LSs classified as New York Heart Association class II, whereas more severe HF was rare (1.8%). Compared with controls, LSs had a substantially increased LVSD risk (odds ratio, 6.6; 95% CI, 2.5 to 17.6; P < .001). A doxorubicin dose ≥ 300 mg/m(2) and cardiac radiation therapy dose greater than 30 Gy were independent risk factors for LVSD.
Conclusion:
LVSD was frequent and HF more prevalent than previously reported in LSs after auto-HCT. Our results may help to identify LSs at increased LVSD risk and can serve as a basis for targeted surveillance strategies.
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