Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma
Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma
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DOI：
10.1200/jco.2007.14.1242
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发表时间：
2008-07-01
影响因子：
45.3
通讯作者：
Jacobson, Judith S.
中科院分区：
文献类型：
--
作者：
Hershman, Dawn L.;McBride, Russell B.;Jacobson, Judith S.
目的蒽环类化疗可提高非霍奇金淋巴瘤患者的生存率，但由于其心脏毒性，老年患者常被拒绝接受。我们研究了心脏的影响，多柔比星在人口为基础的样本中的老年患者弥漫性大B细胞淋巴瘤（DLBCL）。患者和MethodsAmong患者年龄= 65岁诊断DLBCL从1991年至2002年的监测，流行病学，和最终结果，医疗数据库，我们开发了逻辑回归模型的关联多柔比星与人口，临床和心脏变量。然后，我们开发了考克斯比例风险模型之间的关联阿霉素和随后的充血性心力衰竭（CHF），考虑到预测因素CHF consider.ResultsOf 9,438例DLBCL，3,164（42%）接受阿霉素为基础的化疗。任何多柔比星使用与CHF风险增加29%相关（95%CI，1.02 - 1.62）; CHF风险随着多柔比星索赔次数、年龄增加、既往心脏病、合并症、糖尿病和高血压而增加;高血压加强了多柔比星对CHF风险的影响（风险比= 1.8; P = 0.01）。在8年后的诊断，调整CHF无生存率为74%，阿霉素治疗的患者与79%的患者未接受阿霉素治疗。结论在接受化疗的DLBCL患者中，那些以前的心脏病不太可能比其他人接受阿霉素治疗，和那些谁接受阿霉素更有可能比其他人发展CHF。各种心脏危险因素增加CHF风险，但只有高血压与阿霉素有协同作用。多柔比星显著提高了DLBCL患者的生存率;尽管如此，一些亚组可能从降低多柔比星相关CHF风险的努力中获益。
PurposeAnthracycline-based chemotherapy, which improves survival for patients with non-Hodgkin's lymphoma, is often withheld from elderly patients because of its cardiotoxicity. We studied the cardiac effects of doxorubicin in a population-based sample of older patients with diffuse large B-cell lymphoma (DLBCL).Patients and MethodsAmong patients age = 65 years diagnosed with DLBCL from 1991 to 2002 in the Surveillance, Epidemiology, and End Results-Medicare database, we developed logistic regression models of the associations of doxorubicin with demographic, clinical, and cardiac variables. We then developed Cox proportional hazards models of the association between doxorubicin and subsequent congestive heart failure (CHF), taking predictors of CHF into account.ResultsOf 9,438 patients with DLBCL, 3,164 (42%) received doxorubicin-based chemotherapy. Any doxorubicin use was associated with a 29% increase in risk of CHF (95% CI, 1.02 to 1.62); CHF risk increased with number of doxorubicin claims, increasing age, prior heart disease, comorbidities, diabetes, and hypertension; hypertension intensified the effect of doxorubicin on risk of CHF (hazard ratio = 1.8; P = .01). In the 8 years after diagnosis, the adjusted CHF-free survival rate was 74% in doxorubicin-treated patients versus 79% in patients not treated with doxorubicin.ConclusionAmong patients receiving chemotherapy for DLBCL, those with prior heart disease were less likely than others to be treated with doxorubicin, and those who received doxorubicin were more likely than others to develop CHF. Various cardiac risk factors increased CHF risk, but only hypertension was synergistic with doxorubicin. Doxorubicin has dramatically improved survival of DLBCL patients; nonetheless, some subgroups may benefit from efforts to reduce doxorubicin-related CHF risk.