Cardiovascular disease risk after radiotherapy and anthracycline-based chemotherapy for diffuse large B-cell lymphoma
Menée à partir de données portant sur 2 356 personnes ayant survécu au moins 5 ans à un lymphome diffus à grandes cellules B traité entre 1989 et 2012 (durée médiane de suivi : 14,2 ans), cette étude analyse le risque à long terme de maladies cardiovasculaires liées au traitement par radiothérapie et/ou chimiothérapie
Few studies examined treatment-specific long-term risks of cardiovascular diseases (CVD) in diffuse large B-cell lymphoma (DLBCL) survivors treated with potentially cardiotoxic radiotherapy and/or chemotherapy with/without rituximab after the 1990s.Long-term CVD risk was examined in a multicenter cohort comprising 2,356 ≥ 5-year DLBCL survivors treated at ages 15 to 61 years in 1989 to 2012. CVD data were acquired from medical records, general practitioners and disease-registries. Observed CVD-numbers were compared with expected CVD-incidence in the Dutch population to estimate standardized incidence ratios (SIRs) and absolute excess risks (AERs/10,000 person-years). Treatment-specific CVD risks were assessed using multivariable Cox regression.During a median follow-up of 14.2 years (IQR 10.1 to 18.9), 312 survivors were diagnosed with a first CVD ≥5 years after treatment. Compared with the general population, DLBCL survivors had increased risks of heart failure ([HF], SIR 3.9, 95%CI 3.4-4.6, AER 62.8) and cerebrovascular accident (SIR 1.3, 95%CI 1.0 to 1.7, AER 9.8), while risk of coronary artery disease was decreased (SIR 0.7, 95%CI 0.5-0.9, AER -30.9). HF risk was higher among females (SIR 5.3, 95%CI 4.2 to 6.5) than males (SIR 3.2, 95%CI 2.6-4.0, P heterogeneity<0.001), and among survivors ≤40 years at DLBCL treatment (SIR 10.5, 95%CI 7.2 to 14.8, P trend<0.001). Exposure to > 300 mg/m2 doxorubicin was associated with a 2.8-fold (95%CI 1.7-4.5) increased risk of cardiomyopathy/HF, while radiotherapy involving the heart was associated with a 1.9-fold (95%CI 1.1 to 3.1) increased risk of valvular heart disease.≥5-year DLBCL survivors have increased risks of developing CVDs, especially HF. Physicians and patients should recognize this risk, and individualized cardiac screening should be considered.
Journal of the National Cancer Institute , résumé, 2026