Mariana Paola Ferraro1,2,3, Eva Gimeno-Vazquez1,3, Isaac Subirana4,5, Miquel Gómez2,6,7, Javier Díaz2, Blanca Sánchez-González1,3, Francesc García-Pallarols1,3, Laia Martínez1, Mireia Ble6, Lluis Molina2,6,7, Laia Carla Belarte6, Eugenia Abella1,2,3, Roberto Elosua5,8, Josep Comín-Colet6,7,9, Antonio Salar1,2,3. 1. Department of Hematology, Hospital del Mar, Barcelona, Spain. 2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Clinical Hematology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain. 4. CIBER of Epidemiology and Public Health, Barcelona, Spain. 5. Cardiovascular Epidemiology and Genetics Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain. 6. Department of Cardiology, Hospital del Mar, Barcelona, Spain. 7. Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain. 8. CIBER of Cardiovascular Disorders, Barcelona, Spain. 9. Cardiovascular Research Group, Bellvitge Biomedical Research Institute, Hospitalet, Barcelona, Spain.
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.
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.
Authors: Shruti Rajesh Patel; Joerg Herrmann; Robert A Vierkant; Janet E Olson; Fergus J Couch; Antonious Hazim; Jeff A Sloan; Charles L Loprinzi; Kathryn J Ruddy Journal: J Clin Med Date: 2021-07-27 Impact factor: 4.241