Kilickap Saadettin, Yavuz Bunyamin, Aksoy Sercan, Sahiner Levent, Dincer Murat, Harputluoglu Hakan, Erman Mustafa, Aytemir Kudret, Tokgozoglu Lale, Barista Ibrahim
Department of Medical Oncology, Hacettepe University Institute of Oncology, Sihhiye, 06100, Ankara, Turkey.
Med Oncol. 2008;25(4):437-42. doi: 10.1007/s12032-008-9062-2. Epub 2008 Apr 15.
The addition of rituximab to doxorubicin-containing standard chemotherapy significantly improves response to therapy and reduces the risk of death in B-cell non-Hodgkin's lymphoma (NHL) patients. However, the impact of this approach on doxorubicin-induced cardiotoxicity has not been elucidated.
Patients who had been planned to receive CHOP or rituximab plus CHOP (R-CHOP) combination chemotherapy with a diagnosis of NHL were included in the study. In all patients, systolic and diastolic parameters were measured by using conventional and pulsed-wave tissue Doppler echocardiography, which is more sensitive than conventional lead-dependent techniques, both before and in the sixth month of therapy.
There were 28 (M/F; 14/14) patients on CHOP and 33 (M/F; 16/17) patients on R-CHOP. Median age in CHOP and R-CHOP was 49 and 50 years (P = 0.44), respectively. Cumulative doxorubicin doses were 280 and 286 mg/m(2) on CHOP and R-CHOP (P = 0.65), respectively. None of the patients developed clinically evident congestive heart failure. Parameters of systolic function such as LVEF and FS did not significantly change in any patients. In both arms, tissue Doppler parameters of diastolic function such as lateral E and septal E velocity of mitral annulus decreased significantly after therapy (P < 0.001). However, the decrease in diastolic function was similar in both arms (P > 0.05). Conventional Doppler echocardiography yielded consistent findings.
Both CHOP and R-CHOP cause diastolic dysfunction in the early period following their administration. The addition of rituximab to CHOP chemotherapy does not significantly increase the risk of doxorubicin-induced cardiotoxicity during this period.
在含阿霉素的标准化疗中加入利妥昔单抗可显著提高治疗反应率，并降低B细胞非霍奇金淋巴瘤（NHL）患者的死亡风险。然而，这种方法对阿霉素诱导的心脏毒性的影响尚未阐明。
本研究纳入计划接受CHOP或利妥昔单抗联合CHOP（R-CHOP）方案化疗且诊断为NHL的患者。所有患者在治疗前及治疗后第六个月，均采用传统及脉冲波组织多普勒超声心动图测量收缩和舒张参数，该方法比传统的导联依赖技术更敏感。
CHOP组有28例（男/女；14/14）患者，R-CHOP组有33例（男/女；16/17）患者。CHOP组和R-CHOP组的中位年龄分别为49岁和50岁（P = 0.44）。CHOP组和R-CHOP组的阿霉素累积剂量分别为280和286 mg/m²（P = 0.65）。所有患者均未发生临床明显的充血性心力衰竭。任何患者的收缩功能参数如左室射血分数（LVEF）和缩短分数（FS）均未发生显著变化。在两组中，治疗后二尖瓣环侧壁E峰和室间隔E峰等舒张功能的组织多普勒参数均显著降低（P < 0.001）。然而，两组舒张功能的降低程度相似（P > 0.05）。传统多普勒超声心动图也得出了一致的结果。
CHOP和R-CHOP在给药后的早期均可导致舒张功能障碍。在此期间，在CHOP化疗中加入利妥昔单抗不会显著增加阿霉素诱导的心脏毒性风险。
