Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
J Clin Oncol. 2015 Aug 20;33(24):2683-91. doi: 10.1200/JCO.2015.60.8125. Epub 2015 Jul 13.
We aimed to determine the prevalence of left ventricular systolic dysfunction (LVSD), including symptomatic (ie, heart failure [HF]) and asymptomatic LVSD in adult lymphoma survivors (LSs) after autologous hematopoietic stem-cell transplantation (auto-HCT) and to identify risk factors for LVSD in this population.
All LSs treated with auto-HCT as adults in Norway from 1987 to 2008 were eligible for this national cross-sectional study. Asymptomatic LVSD was defined as left ventricular ejection fraction less than 50% by echocardiography, and HF was defined according to current recommendations. The results in LSs were compared with those found in an age- and sex-matched (1:1) control group.
We examined 274 LSs (69% of all eligible survivors); 62% were men, the mean (± standard deviation) age was 56 ± 12 years, and mean follow-up time from lymphoma diagnosis was 13 ± 6 years. The mean cumulative doxorubicin dose was 316 ± 111 mg/m(2), and 35% of LSs had received additional radiation therapy involving the heart. We found LVSD in 15.7% of the LSs, of whom 5.1% were asymptomatic. HF patients were symptomatically mildly affected, with 8.8% of all LSs classified as New York Heart Association class II, whereas more severe HF was rare (1.8%). Compared with controls, LSs had a substantially increased LVSD risk (odds ratio, 6.6; 95% CI, 2.5 to 17.6; P < .001). A doxorubicin dose ≥ 300 mg/m(2) and cardiac radiation therapy dose greater than 30 Gy were independent risk factors for LVSD.
LVSD was frequent and HF more prevalent than previously reported in LSs after auto-HCT. Our results may help to identify LSs at increased LVSD risk and can serve as a basis for targeted surveillance strategies.
我们旨在确定自体造血干细胞移植(auto-HCT)后成人淋巴瘤幸存者(LSs)左心室收缩功能障碍(LVSD)的患病率,包括有症状(即心力衰竭[HF])和无症状 LVSD,并确定该人群中 LVSD 的危险因素。
所有在 1987 年至 2008 年期间在挪威接受 auto-HCT 治疗的成年 LSs 均符合本项全国性横断面研究的条件。无症状性 LVSD 通过超声心动图定义为左心室射血分数低于 50%,心力衰竭根据当前建议进行定义。将 LSs 的结果与年龄和性别匹配(1:1)的对照组进行比较。
我们检查了 274 名 LSs(所有符合条件的幸存者中的 69%);62%为男性,平均(±标准差)年龄为 56±12 岁,从淋巴瘤诊断到随访的平均时间为 13±6 年。平均累积阿霉素剂量为 316±111mg/m2,35%的 LSs 接受了心脏放疗。我们发现 15.7%的 LSs 存在 LVSD,其中 5.1%为无症状。HF 患者症状轻微,所有 LSs 中有 8.8%被归类为纽约心脏协会心功能分级 II 级,而更严重的 HF 则很少见(1.8%)。与对照组相比,LSs 的 LVSD 风险显著增加(比值比,6.6;95%CI,2.5 至 17.6;P<0.001)。阿霉素剂量≥300mg/m2 和心脏放疗剂量大于 30Gy 是 LVSD 的独立危险因素。
自体造血干细胞移植后 LSs 的 LVSD 发生率较高,HF 较以往报道更为常见。我们的结果可能有助于确定 LVSD 风险增加的 LSs,并可为有针对性的监测策略提供依据。