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• W3093574559 abstract "Few data are available comparing cardiovascular diseases (CVD) incidence according to levels of doxorubicin exposure among patients with diffuse large B-cell lymphoma (DLBCL) in Asia. This study was based on a territory-wide electronic database of Hong Kong. We identified adult patients with DLBCL who were histologically diagnosed between 2000 and 2018 and had received chemotherapy. The composite primary outcome was incident CVD after lymphoma diagnosis, including ischemic heart disease, heart failure, and cardiomyopathy clinically detected during inpatient hospital visits or cardiovascular death. Events within the 9-month landmark from lymphoma diagnosis were left-truncated to minimize confounding by early cardiotoxicity. We evaluated the cause-specific cumulative incidence (csCI) of CVD with levels of doxorubicin exposure using flexible parametric competing risk analysis with inverse probability treatment weighting and standardization. Time at risk started from the date of histological DLBCL diagnosis and follow up ended 15 years after diagnosis. csCI of CVD was derived adjusting for demographic, comorbidities, therapeutic exposure, cardiovascular risk, and lifestyle factors which included smoking and alcohol intake. A negative control, constituted from a non-cancer random sample without replacement from family medicine clinics, were age- and sex-matched to DLBCL patients. The CVD csCI for the negative control group was estimated and compared to the csCI from DLBCL patients. 2,600 subjects (median age 63 years, interquartile range: 53 to 73 years, 56.0% male) were enrolled. The median follow-up time was 6.8 years (interquartile range: 3.6–10.5y). We found evidence of confounding by indication. The use of doxorubicin was associated with younger age, lack of cardiovascular risk factors (diabetes, hypertension, and dyslipidemia/hyperlipidemia) and more favorable socioeconomic factor (any need for medical fee waiver) (all p<0.01). Compared with non-doxorubicin regimens, the adjusted cause-specific hazard ratios (HR) for CVD in patients treated with >500mg absolute dose of doxorubicin was 2.77 (95% confidence intervals [CI], 1.27–6.05; p = 0.011). Their 5-, 10- and 15-year cumulative incidence were 8.6%, 12.0%, and 13.6% respectively, versus 3.2 %, 4.5% and 5.2% in the normal controls. There was a trend toward reduced CVD with radiotherapy use (HR 0.62; 95% CI, 0.32–1.20; p = 0.154). In this Asian population-based cohort of DLBCL patients, doxorubicin exposure (especially >500mg) is associated with significant increase in csCI of CVD among survivors. A judicious selection of effective doxorubicin dose and patients for doxorubicin-based treatment is important. Furthermore, in addition to careful counseling, the development of risk-adapted monitoring and follow-up of susceptible DLBCL patients is advisable." @default.
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• W3093574559 date "2020-11-01" @default.
• W3093574559 modified "2023-10-18" @default.
• W3093574559 title "Doxorubicin and Subsequent Incident Risks of Cardiovascular Diseases in Diffuse Large B-Cell Lymphoma Long-Term Survivors" @default.
• W3093574559 doi "https://doi.org/10.1016/j.ijrobp.2020.07.883" @default.
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