Cardiovascular diseases among diffuse large B-cell lymphoma long-term survivors in Asia: a multistate model study

Area of Science:

• Oncology
• Cardiology
• Epidemiology

Background:

• Diffuse large B-cell lymphoma (DLBCL) is a significant hematologic malignancy.
• Cardiovascular diseases (CVDs) represent a growing concern for DLBCL survivors.
• Understanding the interplay between DLBCL treatment and CVD development is crucial for patient outcomes.

Purpose of the Study:

• To model the clinical course of DLBCL patients, focusing on the development of incident cardiovascular diseases (CVDs).
• To quantify the impact of doxorubicin and various risk factors on the clinical course of DLBCL.
• To analyze transitions into incident CVD, lymphoma death, and other causes of death.

Main Methods:

• A multistate modeling framework, specifically a Markov illness-death model, was employed.
• Data from 2600 DLBCL patients diagnosed between 2000-2018 in Hong Kong were analyzed.
• The model assessed the influence of therapeutic exposure, demographics, comorbidities, cardiovascular risk factors, and lifestyle factors.

Main Results:

• 23.6% of patients died of lymphoma, and 8.8% developed incident CVD over a median follow-up of 7.0 years.
• Older age, hypertension, diabetes, and baseline aspirin use were significantly associated with increased CVD risk.
• Higher-risk patients (older, smokers, diabetic, on doxorubicin) spent minimal time in the CVD state, indicating high mortality.

Conclusions:

• Incident CVDs frequently occur early and persist throughout survivorship in DLBCL patients.
• Clinicians should carefully weigh treatment risks and benefits to mitigate CVD development.
• This study highlights the importance of proactive cardiovascular risk management in DLBCL survivors.