Nakayama Takafumi, Oshima Yoshiko, Kusumoto Shigeru, Yamamoto Junki, Osaga Satoshi, Fujinami Haruna, Kikuchi Takaki, Suzuki Tomotaka, Totani Haruhito, Kinoshita Shiori, Narita Tomoko, Ito Asahi, Ri Masaki, Komatsu Hirokazu, Wakami Kazuaki, Goto Toshihiko, Sugiura Tomonori, Seo Yoshihiro, Ohte Nobuyuki, Iida Shinsuke
Department of Cardiology Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
Department of Hematology and Oncology Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
EJHaem. 2020 Oct 3;1(2):498-506. doi: 10.1002/jha2.110. eCollection 2020 Nov.
We investigated the incidence of cardiotoxicity, its risk factors, and the clinical course of cardiac function in patients with malignant lymphoma (ML) who received a cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) regimen. Among all ML patients who received a CHOP regimen with or without rituximab from January 2008 to December 2017 in Nagoya City University hospital, 229 patients who underwent both baseline and follow-up echocardiography and had baseline left ventricular ejection fraction (LVEF) ≥50% were analyzed, retrospectively. Cardiotoxicity was defined as a ≥10% decline in LVEF and LVEF < 50%; recovery from cardiotoxicity was defined as a ≥5% increase in LVEF and LVEF ≥50%. Re-cardiotoxicity was defined as meeting the criteria of cardiotoxicity again. With a median follow-up of 1132 days, cardiotoxicity, symptomatic heart failure, and cardiovascular death were observed in 48 (21%), 30 (13%), and 5 (2%) patients, respectively. Multivariate analysis demonstrated that history of ischemic heart disease (hazard ratio (HR), 3.15; 95% CI, 1.17-8.47, = .023) and decreased baseline LVEF (HR per 10% increase, 2.55; 95% CI, 1.49-4.06; < .001) were independent risk factors for cardiotoxicity. Recovery from cardiotoxicity and re-cardiotoxicity were observed in 21 of 48, and six of 21, respectively. Cardiac condition before chemotherapy seemed to be most relevant for developing cardiotoxicity. Furthermore, Continuous management must be required in patients with cardiotoxicity, even after LVEF recovery.
我们调查了接受环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）方案的恶性淋巴瘤（ML）患者的心脏毒性发生率、危险因素及心功能的临床病程。回顾性分析了2008年1月至2017年12月在名古屋市立大学医院接受含或不含利妥昔单抗CHOP方案的所有ML患者中，229例接受了基线和随访超声心动图检查且基线左心室射血分数（LVEF）≥50%的患者。心脏毒性定义为LVEF下降≥10%且LVEF<50%；心脏毒性恢复定义为LVEF增加≥5%且LVEF≥50%。再发心脏毒性定义为再次符合心脏毒性标准。中位随访1132天，分别有48例（21%）、30例（13%）和5例（2%）患者出现心脏毒性、症状性心力衰竭和心血管死亡。多因素分析表明，缺血性心脏病史（风险比（HR），3.15；95%可信区间，1.17 - 8.47，P = 0.023）和基线LVEF降低（每增加10%的HR，2.55；95%可信区间，1.49 - 4.06；P<0.001）是心脏毒性的独立危险因素。48例中有21例出现心脏毒性恢复，21例中有6例出现再发心脏毒性。化疗前的心脏状况似乎与发生心脏毒性最相关。此外，即使LVEF恢复，心脏毒性患者仍需持续管理。
