Abstract 189: Surveillance and Management of Lymphoma Patients Receiving Anthracycline Based Chemotherapy
Background: Cardiotoxicity is one of the most common and devastating complications of anthracyline-based chemotherapy (AC). The AHA recommends routine surveillance, early diagnosis and treatment of AC induced cardiomyopathy (CMP). We assessed the pattern of surveillance of left ventricular ejection fraction (LVEF) and management of AC-CMP.
Methods: We performed a retrospective analysis of a cohort of Non-Hodgkin lymphoma (NHL) patients evaluated by the Emory Lymphoma program who received AC between 1992 and 2013. We assessed cardiac function by echocardiogram or equilibrium radionuclide imaging. We also examined the prevalence of AC-CMP (defined as an absolute decrease in LVEF > 10% with a decline <50%, or an LVEF reduction of at least 15% with absolute LVEF > 50%) and quality of care of AC-CMP based on AHA heart failure guidelines including treatment with beta-blockers and ACE-inhibitors. Finally, we reviewed echocardiograms to assess echocardiographic measures of diastolic function.
Results: Of 218 patients who received AC (median dose 300 mg/m2), 41% (89 of 218) had imaging surveillance before and after AC (Table 1). LVEF was evaluated by limited echo in 52% (46 of 89), comprehensive echo in 32% (29 of 89) and MUGA in 16% (14 of 89) of patients. Diastolic function was evaluated in only 20% (15 of 75) of patients. Twenty seven percent of patients (24 of 89) had AC-CMP, out of which 17% (15 of 89) had moderate-severe decrease in LVEF < 45%. Of patients with LVEF < 45%, only 47% (7 of 15) received ACE Inhibitors, 40% (6 of 15) received beta-blockers and 40% (6 of 15) had repeat assessment of LVEF. Notably, 46% (11 of 24) of patients with AC-CMP were asymptomatic and 42% (10 of 24) were symptomatic.
Conclusions: Less than half of NHL patients treated with AC receive surveillance and treatment according to AHA guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of oncology patients receiving AC.
Author Disclosures: J.R. Brown: None. C.R. Flowers: None. T. Dai: None. S. Parashar: None.
- © 2014 by American Heart Association, Inc.