Cardio-oncology for better lymphoma therapy outcomes
A partir d'une revue systématique de la littérature publiée entre 1984 et 2019 (137 études, 21 211 patients), cette méta-analyse évalue la survenue d'événements indésirables de nature cardiovasculaire chez des patients atteints d'un lymphome non hodgkinien traité par une chimiothérapie de première ligne de type CHOP (cyclophosphamide, doxorubicine, vincristine et prednisone) ou de type R-CHOP (durée médiane de suivi : 39 mois)
At least a third of the more than half a million patients worldwide who are diagnosed with lymphoma every year are treated with a regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone, with (R-CHOP) or without (CHOP) rituximab. Doxorubicin cardiotoxicity has been investigated thoroughly, therefore, clear recommendations for full implementation in everyday clinical practice could be expected. However, in The Lancet Haematology, the systematic review and meta-analysis by Marijke Linschoten and colleagues, one of the largest to date and based on results of 137 clinical studies (with over 21 000 patients), showed that this is not the case. Although this meta-analysis was done during the era of cardio-oncology (patients were treated between 1984 and 2019), when doxorubicin cardiotoxicity was known to be an adverse effect, cardiac systolic function was assessed after treatment only in 14 (10%) of 137 studies. This strategy clearly goes against American Society of Clinical Oncology guidelines, and European Society for Medical Oncology recommendations. Cardiac assessment, including echocardiography, should be regarded as necessary for all asymptomatic patients within 6–12 months of completing an anthracycline-containing regimen, as most episodes of cardiotoxicity occur during this period. Long-term cardiac surveillance with echocardiography monitoring has become a duty of specialised cardio-oncology centres.
The Lancet Haematology , commentaire, 2019