University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
J Adolesc Young Adult Oncol. 2023 Jun;12(3):331-339. doi: 10.1089/jayao.2022.0062. Epub 2022 Sep 2.
Anthracyclines can cause long-term cardiovascular (CV) morbidity, especially in long-term Adolescent and Young Adult (AYA) lymphoma survivors. Pre-treatment left ventricular ejection fraction (LVEF) evaluation is recommended, although its utility in AYA is not established. We sought to determine the pre-treatment LVEF assessment practices in AYA lymphoma survivors treated with anthracyclines and factors associated with long-term cardiotoxicity. Through an electronic health records review, we retrospectively identified AYA lymphoma survivors with ≥5 years of follow-up postanthracycline treatment. Pre-treatment and follow-up data were abstracted. CV health conditions were defined as risk factors for CV disease and confirmed CV diagnoses. Survivors who had new CV health conditions at follow-up were compared to those who were not using descriptive statistics and logistic regression. One hundred fifteen AYA lymphoma survivors met the study criteria. Pre-treatment LVEF assessment did not affect chemotherapy decisions. Survivors with pre-treatment CV evaluation had mean follow-up since diagnosis of 8 ± 3.3 years, while survivors without it had 10.3 ± 4.2 years, < 0.05. Survivors with pre-treatment LVEF assessment received lower cumulative anthracycline dose (240.4 mg/m vs. 280.1 mg/m, < 0.05) and fewer cycles of chemotherapy (4.8 ± 1.5 vs. 5.6 ± 1.2, < 0.05). Body mass index (BMI) category at diagnosis and follow-up, in addition to age were associated with development of new CV health conditions, pre-treatment LVEF evaluation was not. Pre-treatment LVEF assessment for AYA lymphoma survivors does not impact oncologic treatment decisions or development of CV health conditions. It may be more valuable to assess and modify CV risk factors such as BMI for CV disease prevention.
蒽环类药物可导致长期心血管（CV）发病率，尤其是在长期青少年和年轻成人（AYA）淋巴瘤幸存者中。建议进行左心室射血分数（LVEF）评估，但在 AYA 中的实用性尚未确定。我们旨在确定接受蒽环类药物治疗的 AYA 淋巴瘤幸存者的治疗前 LVEF 评估方法以及与长期心脏毒性相关的因素。通过电子病历回顾，我们回顾性地确定了接受蒽环类药物治疗后随访时间≥5 年的 AYA 淋巴瘤幸存者。提取了治疗前和随访数据。心血管健康状况定义为心血管疾病的危险因素和已确诊的心血管疾病。将随访时有新的心血管健康状况的幸存者与无该状况的幸存者进行比较，采用描述性统计和逻辑回归分析。115 名 AYA 淋巴瘤幸存者符合研究标准。治疗前 LVEF 评估不影响化疗决策。接受治疗前 CV 评估的幸存者自诊断后的平均随访时间为 8 ± 3.3 年，而未接受评估的幸存者为 10.3 ± 4.2 年，<0.05。接受治疗前 LVEF 评估的幸存者接受的累积蒽环类药物剂量（240.4mg/m 比 280.1mg/m，<0.05）和化疗周期（4.8 ± 1.5 比 5.6 ± 1.2，<0.05）更少。诊断和随访时的体重指数（BMI）类别以及年龄与新发生心血管健康状况有关，而治疗前 LVEF 评估与新发生心血管健康状况无关。治疗前 LVEF 评估对 AYA 淋巴瘤幸存者的肿瘤治疗决策或心血管健康状况的发展没有影响。评估和修改 BMI 等心血管危险因素可能更有助于预防心血管疾病。
