Anthracycline-induced cardiotoxicity in diffuse large B-cell lymphoma: NT-proBNP and cardiovascular score for risk stratification.

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.

• Authors: Mariana Paola Ferraro, Eva Gimeno-Vazquez, Isaac Subirana, Miquel Gómez, Javier Díaz, Blanca Sánchez-González, Francesc García-Pallarols, Laia Martínez, Mireia Ble, Lluis Molina, Laia Carla Belarte, Eugenia Abella, Roberto Elosua, Josep Comín-Colet, Antonio Salar
• Journal: European journal of haematology (Eur J Haematol) Vol. 102 Issue 6 Pg. 509-515 (Jun 2019) ISSN: 1600-0609 [Electronic] England
• PMID: 30972815 (Publication Type: Journal Article)
• Copyright: © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Anthracyclines
• Antineoplastic Agents
• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Aged
• Anthracyclines (adverse effects, therapeutic use)
• Antineoplastic Agents (adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Biomarkers
• Cardiotoxicity
• Female
• Heart Diseases (blood, diagnosis, etiology)
• Humans
• Lymphoma, Large B-Cell, Diffuse (complications, drug therapy, mortality)
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Spain