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

ESMO Open

article

S.F. Lee¹  B.A. Vellayappan³  L.C. Wong³  C.L. Chiang¹  S.K. Chan¹  E.Y.-F. Wan⁴  I.C.-K. Wong⁴  P.C. Lambert⁸  B. Rachet^1,10  A.K. Ng^1,11  M.A. Luque-Fernandez⁵ 

[1] Department of Clinical Oncology, The University of Hong Kong;Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority;Department of Radiation Oncology, National University Cancer Institute;Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong;Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong;Laboratory of Data Discovery for Health ,(D24H), Hong Kong Science and Technology Park;Research Department of Policy and Practice, School of Pharmacy, University College London;Biostatistics Research Group, Department of Health Sciences, University of Leicester;Department of Medical Epidemiology and Biostatistics, Karolinska Institutet;Department of Non-Communicable Disease Epidemiology, ICON Group, London School of Hygiene and Tropical Medicine;Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School;Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada ,(ibs.GRANADA), Andalusian School of Public Health

关键词: non-Hodgkin’s lymphoma;    diffuse large B-cell lymphoma;    chemotherapy;    radiotherapy;    survival;   

DOI  :  10.1016/j.esmoop.2021.100363

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background We modeled the clinical course of a cohort of diffuse large B-cell lymphoma (DLBCL) patients with no prior cardiovascular diseases (CVDs) using a multistate modeling framework.Patients and methods Data on 2600 patients with DLBCL diagnosed between 2000 and 2018 and had received chemotherapy with or without radiotherapy were obtained from a population-wide electronic health database of Hong Kong. We used the Markov illness-death model to quantify the impact of doxorubicin and various risk factors (therapeutic exposure, demographic, comorbidities, cardiovascular risk factors, and lifestyle factors which included smoking) on the clinical course of DLBCL (transitions into incident CVD, lymphoma death, and other causes of death).Results 75 versus ≤60 years 1.88; 95% confidence interval (CI) 1.25-2.82 and HR for 61-75 versus ≤60 years 1.60; 95% CI 1.12-2.30], hypertension (HR 4.92; 95% CI 2.61-9.26), diabetes (HR 1.43; 95% CI 1.09-1.87), and baseline use of aspirin (HR 5.30; 95% CI 3.93-7.16) were associated with an increased risk of incident CVD. In a subgroup of anticipated higher-risk patients (aged 61-75 years, smoked, had diabetes, and received doxorubicin), we found that they remained on average 7.9 (95% CI 7.2-8.8) years in the DLBCL state and 0.1 (95% CI 0.0-0.4) years in the CVD state, if they could be followed up for 10 years. The brief time in the CVD state is consistent with the high chance of death in patients who developed CVD. Other causes of death have overtaken DLBCL-related death after about 5 years.Conclusions In this Asian population-based cohort, we found that incident CVDs can occur soon after DLBCL treatment and continued to occur throughout survivorship. Clinicians are advised to balance the risks and benefits of treatment choices to minimize the risk of CVD.

【 授权许可】

CC BY|CC BY-NC-ND