scholarly journals Utility of Routine Left Ventricular Ejection Fraction Measurement Before Anthracycline-Based Chemotherapy in Patients With Diffuse Large B-Cell Lymphoma

2012 ◽  
Vol 8 (6) ◽  
pp. 336-340 ◽  
Author(s):  
Amber L. Conrad ◽  
Jacob D. Gundrum ◽  
Vicki L. McHugh ◽  
Ronald S. Go
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Large B Cell Lymphoma ◽  
Fraction Measurement ◽  
Large B Cell

The authors' findings challenge the utility of routine LVEF measurement in patients with diffuse large B-cell lymphoma before anthracycline-based chemotherapy.

scholarly journals Left Ventricular Ejection Fraction Measurement and Doxorubicin-Based Chemotherapy in Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1300-1300
Author(s):  
Deborah L Enns ◽  
David M Aboulafia
Keyword(s):  
Risk Factors ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Large B Cell Lymphoma ◽  
The Mean ◽  
Large B Cell

Abstract Purpose: Doxorubicin-based chemotherapy (DOX) is commonly administered to patients with diffuse large B-cell lymphoma (DLBCL). Prior to chemotherapy, left ventricular ejection fraction (LVEF) is routinely measured to assess left ventricular dysfunction. While LVEF screening is recommended by many national regulatory bodies, evidence supporting the usefulness of LVEF measurement prior to administering DOX is lacking. Our goal was to perform a retrospective analysis of patients with DLBCL to establish (1) how often LVEF was measured prior to administering DOX, and (2) whether the chemotherapy regimen was modified based on LVEF values. As cumulative doses of doxorubicin greater than 400 mg/m2 have been associated with an increased risk of congestive heart failure (CHF), we also determined the incidence of CHF in patients with DLBCL who did receive DOX. Patients and Methods: We identified 268 patients diagnosed with DLBCL at Virginia Mason Medical Center between 2001 and 2012 and collected the following data: age at diagnosis; stage of lymphoma; type of chemotherapy given; cumulative doxorubicin dose (mg/m2); LVEF status; and incidence of CHF or cardiac disease. We also compared the number of CHF risk factors between patients who did and did not have LVEF measured. Statistical analyses included a Fischer’s exact or Chi-squared test to compare study groups as well as the number of CHF risk factors. The level of significance was set at a P value of < 0.05. Results: LVEF was measured in 238 patients (89%) prior to initiation of chemotherapy. LVEF values were normal in 225 patients (95%) and low (< 50%) in 13 patients (5%). Of the patients with normal LVEF, 193 received DOX (86%), and of these patients, 14 developed CHF post-treatment (7%). For the 13 patients with low LVEF, 8 received DOX (62%) and 1 developed post-treatment CHF (13%). The remaining thirty patients did not have LVEF measured and none received DOX. Of the 268 patients studied, 176 are alive (66%) and 3 were lost to follow-up. The mean follow-up time was 43 months (range 3 d to 12.1 y). The mean number of CHF risk factors did not differ between patients who did and did not have LVEF measured (1.70 vs. 1.65, P = 0.87). Conclusion: Our results suggest that the decision to administer DOX was not directly affected by LVEF values. These findings challenge the existing policy of routinely screening patients with DLBCL with echocardiograms or MUGA scans prior to treatment. Disclosures No relevant conflicts of interest to declare.

scholarly journals Intravascular Large B-cell Lymphoma with Left Ventricular Dysfunction

2008 ◽  
Vol 97 (7) ◽  
pp. 1666-1668
Author(s):  
Toshimi Imai ◽  
Yoshioki Nishimura ◽  
Mitsunobu Murata ◽  
Toshinobu Saitou ◽  
Keiji Yamamoto ◽  
...  
Keyword(s):  
B Cell ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Comparative efficacy of tisagenlecleucel (tisa-cel) and lisocabtagene maraleucel (liso-cel) in patients with relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7535-7535
Author(s):  
Stephen J. Schuster ◽  
Jie Zhang ◽  
Hongbo Yang ◽  
Abhijit Agarwal ◽  
Wenxi Tang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
B Cell ◽  
Cell Lymphoma ◽  
Indirect Comparison ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Sensitivity Analyses ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ecog Ps

7535 Background: Chimeric antigen receptor T-cell therapies tisa-cel and liso-cel are effective treatments for r/r DLBCL (Schuster 2019, Abramson 2020). This study compared efficacy outcomes of tisa-cel and liso-cel in r/r DLBCL using matching-adjusted indirect comparison (MAIC). Methods: Individual patient-level data (IPD) from JULIET (tisa-cel; NCT02445248; 02/2020 datacut) were weighted to match the patient population in TRANSCEND (liso-cel; NCT02631044; 08/2019 datacut). Baseline prognostic factors available in both trials were adjusted for age, sex, histology, ECOG performance status [ECOG PS], left ventricular ejection fraction, radiologic sum of product diameters, lactate dehydrogenase, prior stem cell transplantation [SCT], use of bridging therapy, and number of and refractoriness to prior therapies, in the MAIC. Overall survival (OS), progression-free survival (PFS), complete response (CR) rate, and overall response (OR) rate were compared. Primary analyses compared infused patients in JULIET (N=106, excluding 8 without lymphodepleting chemotherapy [LDC] and 1 large cell neuroendocrine carcinoma) with efficacy-evaluable set in TRANSCEND (N=256, infused patients). A scenario analysis compared JULIET infused to TRANSCEND primary analysis set (PAS) (N=133, dose level 2, excluding those with ECOG PS 2, prior allogeneic SCT, primary mediastinal B-cell lymphoma, follicular lymphoma [FL] 3B, or transformation from indolent lymphoma besides FL). Sensitivity analyses included JULIET patients with only fludarabine-based LDC or only adjusted significantly different baseline prognostic factors. Safety outcomes were not compared because adverse event management has evolved and differed between the two trials; MAIC is unable to adjust for such differences. Results: After adjusting for differences in baseline characteristics, OS, PFS, and CR were comparable between tisa-cel infused patients and the liso-cel efficacy-evaluable set (Table). The results were consistent across all scenario and sensitivity analyses. OR rate trended higher in the TRANSCEND efficacy-evaluable set (72.7% vs. 62.9%, p=0.07) and was higher in TRANSCEND PAS than in the respectively matched JULIET infused set (74.4% vs. 60.9%, p < 0.05). Conclusions: The MAIC results indicate there is no evidence suggesting differences in OS, PFS and CR between tisa-cel and liso-cel in r/r DLBCL. Analyses using IPD from both trials and/or real-world evidence are warranted to confirm these findings.[Table: see text]

Primary cardiac plasmablastic (diffuse large B-cell) lymphoma mimicking left ventricular aneurysm with mural thrombus

2007 ◽  
Vol 16 (2) ◽  
pp. 111-114 ◽  
Author(s):  
Dylan V. Miller ◽  
Farouk Mookadam ◽  
Martina Mookadam ◽  
William D. Edwards ◽  
William R. Macon
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Left Ventricular Aneurysm ◽  
Mural Thrombus ◽  
Ventricular Aneurysm ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Usefulness of NT-Probnp Levels and Fresco Cardiovascular Risk Scale for Prediction of Myocardiotoxicity Induced By Anthracyclines in Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 925-925
Author(s):  
Mariana Paola Ferraro ◽  
Eva Gimeno ◽  
Miquel Gomez ◽  
Francesc Garcia-Pallarols ◽  
Silvia Perez ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
B Cell ◽  
Cumulative Incidence ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Left Ventricular Ejection ◽  
Large B Cell Lymphoma ◽  
C Statistic ◽  
Large B Cell

Abstract Introduction: Anthracyclines are cytotoxic antibiotics used in the treatment of lymphomas. Myocardiopathy is a well-known toxicity of anthracyclines, and both acute/subacute and late-onset presentations have been described. Early detection of asymptomatic cardiac dysfunction and identification of biomarkers for anthracycline cardiotoxicity risk may be important to prevent irreversible heart damage. Objective: To prospectively evaluate the incidence, time of appearance and clinico-biological variables associated with the development of myocardiotoxicity in patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP/R-CHOP-like regimens. Patients and Methods: one hundred and sixty six patients with DLBCL from 05/2004 to 05/2014. Excluded: HIV infection (10), treatment without anthracyclines (21) and other causes (5) (Table 1). Left ventricular ejection fraction (LVEF) determined by high resolution echocardiography and the N-terminal brain natriuretic peptide (NT-proBNP) fragment were done prior initiation of treatment, at the end and every 6-12 months thereafter. Myocardiotoxicity was defined as: LVEF <55% or decrease >15% if prior LVEF <55% and/or clinical manifestations of heart failure (CHF). The FRESCO scale that accurately estimates 10-year cardiovascular risk in the adult European population was used to estimate cardiovascular risk. The C statistic for NT-proBNP and FRESCO scale was determined and competitive risk analysis was performed in the evaluation of myocardiotoxicity. Results: median age 68 years (IQR: 54-75), 51% male, median NT-proBNP 251.8 pg/mL (IQR: 76.2-560.1), median LVEF 64% (IQR: 60-69%) and median FRESCO scale 4.5 (IQR 2.1-7.2). NT-proBNP was correlated with FRESCO scale, but not with LVEF. With a median follow-up of 64.7 months (95% CI 56.4-73.6) 24 cardiac events were observed (5 clinical CHF + normal LVEF, 7 clinical CHF + LVEF low and 12 low LVEF without clinical CHF). Cumulative incidence of myocardiotoxicity was 8.8% at 6 months (95% CI 5.0 to 15.3), 12.3% at 12 months (95% CI 7.6 to 19.6), 14.2% at 24 months (95% CI 9.1 to 21.9) and 17.6% at 5 years (95% CI 11.6 to 26.1). C statistic for myocardiotoxicity was: FRESCO scale 0.7192 (95%CI: 0.6284- 0.8099) and FRESCO scale+NT-proBNP 0.807 (95%CI: 0.7309-0.8832). Competing risks analysis showed a significantly increased cumulative incidence of myocardiotoxicity in patients with NT-proBNP >600 +/- FRESCO >4.5 (Figure 1). Finally, we performed a computational modeling using 12 Bayesian networks to analyze the connections between demographic characteristics, cardiovascular risk factors, treatment, occurrence of cardiotoxicity and death (Figure 2 illustrates one of the networks). Conclusions: myocardiotoxicity induced by anthracyclines remains an important problem in the daily practice. The FRESCO cardiovascular risk function is useful for predictingmyocardiotoxicity and levels of NT-proBNP improved accuracy myocardiotoxicity risk. We propose that patients with NT-proBNP >600 pg/mL or FRESCO > 4.5 should have a specific cardiologic surveillance and follow-up in cardio-oncology units from the start of their anthracyclin-containing chemotherapy. Disclosures No relevant conflicts of interest to declare.

Elevated High Sensitivity Troponin T (HsTnT) during Front-Line Therapy with Cyclophosphamide, Doxorubicin, Vincristine and Prednisone +/- Rituximab (CHOP+/-R) or Cyclophosphamide, Epirubicin, Vincristine and Prednisone +/- Rituximab (CEpOP+/-R) Correlates with a Decline in Left Ventricular Ejection Fraction (LVEF) in Patients with Aggressive B-Cell Lymphoma: Results from a Randomized Prospective Clinical Trial NCT00854568

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3041-3041
Author(s):  
Kai Xue ◽  
Juan J Gu ◽  
Qunling Zhang ◽  
Xiaojian Liu ◽  
Jiachen Wang ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Troponin T ◽  
Combined Treatment ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Treatment Groups ◽  
Number Of Patients

Abstract Anthracycline associated cardiomyopathy (AAC) is a rare but real complication that negatively influence the clinical outcome and quality of life in B-cell lymphoma patients. Guidelines for cardiac monitoring during chemotherapy had been formulated but are primarily based on cardiac imaging. On the other hand, current available cardiac imaging studies only detect changes once significant myocardial damage has occurred. Thus, there is a need to identify, test and validate novel biomarkers that may predict early cardiac injury in cancer patients receiving cardio-toxic agents. Recently introduced into the clinical practice, high sensitivity troponin T (HsTnT) assay has allowed unparalleled sensitivity and precision to detect early myocardial injury. To this end, we prospectively evaluated changes in HsTnT levels during chemotherapy and correlated it with changes in left ventricular ejection fraction (LVEF) and/or incidence of AAC in previously untreated diffuse large B-cell lymphoma (DLBCL) patients enrolled in a phase III clinical trial comparing two chemotherapy regimens CHOP+/-R vs. CEpOP+/-R, (NCT00854568). A total of 348 DLBCL (N=315) or follicular lymphoma grade 3 (FLG3) (N=33) were randomized to receive either 6 cycles of CHOP+/-R or CEpOP+/-R administered on a 21 day cycles. Demographic, clinical and pathological characteristics were collected for each patient. In addition, baseline and after 4 cycles of the planned therapy were completed, cardiac multi gated acquisition [MUGA] scan and HsTnT using one-step electrochemiluminescence immunoassay (Roche cobase 411) were performed. Treatment groups were well balanced in terms of clinical and demographic characteristics. After 27.1 month follow up, there was no difference in terms of overall response rate (ORR) and progression free survival (PFS) between CHOP+/-R or CEpOP+/-R (Estimated 3-year PFS: 79.7±3.3 % vs. 80.0±3.4%, P = 0.958). Cardiac biomarkers were collected in 324 patients. Elevated HsTnT values after 4 cycles of therapy were observed in 30.9% and changes in LVEF were detected only in 16.0 % of the patients. In detail, elevated levels of HsTnT were observed in 100/324 patients, 66/157 in the CHOP+/-R group and 34/167 in the CEpOP+/-R group (42.0% vs. 20.4%, P = 0.001) (Figure 1). All these patients were asymptomatic, clinically and hemodynamically stable. Moreover, there was no difference between these two groups in terms of incidence of decreased LVEF (27/168, 16.1% vs. 27/180, 15.0%, P = 0.783). Patients with an elevated HsTnT after 4 cycles of their planned treatment exhibited a more pronounced decrease in the absolute LVEF than patients with stable HsTnT levels (P = 0.009) (Figure 2). Our data suggest that while CHOP+/-R or CEpOP+/-R are equivalent in terms of clinical activity; CEpOP+/-R is associated with a lower incidence of HsTnT elevation. Subclinical decrease in LVEF was associated with elevations on HsTnT in the patient population studied suggesting that HsTnT can potentially be applied as a serum biomarker to identify patients at risk for AAC. Longer follow up is required to further define if the differences observed on HsTnT changes between CHOP+/-R and CEpOP+/-R treated patients will translate in differences in the incidence of clinically relevant AAC. Figure 1. Incidence of adverse cardiac event defined as decrease in LVEF by ≥ 10% or elevated HsTnT levels in DLBCL patients treated with either CHOP+/-R or CEpOP+/-R. While changes in LVEF were similar between treatment arms, a significantly higher number of patients in the CHOP+/-R group exhibited elevation of HsTnT levels after 4 cycles of planed therapy. *P = 0.001 Figure 1. Incidence of adverse cardiac event defined as decrease in LVEF by ≥ 10% or elevated HsTnT levels in DLBCL patients treated with either CHOP+/-R or CEpOP+/-R. While changes in LVEF were similar between treatment arms, a significantly higher number of patients in the CHOP+/-R group exhibited elevation of HsTnT levels after 4 cycles of planed therapy. *P = 0.001 Figure 2. Correlation between changes in HsTnT levels and LVEF. In the combined treatment groups (CHOP+/-R and CEpOP+/-R ), DLBCL patients with elevated HsTnT levels after 4 cycles of therapy had a more pronounced decline in LVEF than patients with normal HsTnT levels.*P = 0.009 Figure 2. Correlation between changes in HsTnT levels and LVEF. In the combined treatment groups (CHOP+/-R and CEpOP+/-R ), DLBCL patients with elevated HsTnT levels after 4 cycles of therapy had a more pronounced decline in LVEF than patients with normal HsTnT levels.*P = 0.009 Disclosures No relevant conflicts of interest to declare.

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