Myocardial infarction in diffuse large B-cell lymphoma patients – a population-based matched cohort study
(2021) In Journal of Internal Medicine 290(5). p.1048-1060- Abstract
Background: The outcome for diffuse large B-cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R-CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. Method: We identified 3548 curatively treated DLBCL patients in Sweden diagnosed between 2007 and 2014, and 35474 matched lymphoma-free general population comparators. The incidence, characteristics and outcome of acute myocardial infarctions (AMIs) were assessed using population-based registers up to 11 years after diagnosis. The rate of AMI was estimated using flexible parametric models. Results: Overall, a... (More)
Background: The outcome for diffuse large B-cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R-CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. Method: We identified 3548 curatively treated DLBCL patients in Sweden diagnosed between 2007 and 2014, and 35474 matched lymphoma-free general population comparators. The incidence, characteristics and outcome of acute myocardial infarctions (AMIs) were assessed using population-based registers up to 11 years after diagnosis. The rate of AMI was estimated using flexible parametric models. Results: Overall, a 33% excess rate of AMI was observed among DLBCL patients compared with the general population (HR: 1.33, 95% CI: 1.14–1.55). The excess rate was highest during the first year after diagnosis and diminished after 2 years. High age, male sex and comorbidity were the strongest risk factors for AMI. Older patients (>70 years) with mild comorbidities (i.e. hypertension or diabetes) had a 61% higher AMI rate than comparators (HR: 1.61, 95% CI: 1.10–2.35), whereas the corresponding excess rate was 28% for patients with severe comorbidities (HR: 1.28, 95% CI: 1.01–1.64). Among younger patients (≤70), a short-term excess rate of AMI was limited to those with severe comorbidities. There was no difference in AMI characteristics, pharmacological treatment or 30-day survival among patients and comparators. Conclusion: DLBCL patients have an increased risk of AMI, especially during the first 2 years, which calls for improved cardiac monitoring guided by age and comorbidities. Importantly, DLBCL was not associated with differential AMI management or survival.
(Less)
- author
- Ekberg, S. LU ; Harrysson, S. ; Jernberg, T. ; Szummer, K. ; Andersson, P. O. ; Jerkeman, M. LU ; Smedby, K. E. and Eloranta, S.
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acute myocardial infarction, cardiology, epidemiology, lymphoma
- in
- Journal of Internal Medicine
- volume
- 290
- issue
- 5
- pages
- 1048 - 1060
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:34003533
- scopus:85105965055
- ISSN
- 0954-6820
- DOI
- 10.1111/joim.13303
- language
- English
- LU publication?
- yes
- id
- 92b51d53-4258-4b4f-b1a9-c7c270927f7c
- date added to LUP
- 2021-06-09 15:26:03
- date last changed
- 2024-06-15 12:18:48
@article{92b51d53-4258-4b4f-b1a9-c7c270927f7c,
abstract = {{<p>Background: The outcome for diffuse large B-cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R-CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. Method: We identified 3548 curatively treated DLBCL patients in Sweden diagnosed between 2007 and 2014, and 35474 matched lymphoma-free general population comparators. The incidence, characteristics and outcome of acute myocardial infarctions (AMIs) were assessed using population-based registers up to 11 years after diagnosis. The rate of AMI was estimated using flexible parametric models. Results: Overall, a 33% excess rate of AMI was observed among DLBCL patients compared with the general population (HR: 1.33, 95% CI: 1.14–1.55). The excess rate was highest during the first year after diagnosis and diminished after 2 years. High age, male sex and comorbidity were the strongest risk factors for AMI. Older patients (>70 years) with mild comorbidities (i.e. hypertension or diabetes) had a 61% higher AMI rate than comparators (HR: 1.61, 95% CI: 1.10–2.35), whereas the corresponding excess rate was 28% for patients with severe comorbidities (HR: 1.28, 95% CI: 1.01–1.64). Among younger patients (≤70), a short-term excess rate of AMI was limited to those with severe comorbidities. There was no difference in AMI characteristics, pharmacological treatment or 30-day survival among patients and comparators. Conclusion: DLBCL patients have an increased risk of AMI, especially during the first 2 years, which calls for improved cardiac monitoring guided by age and comorbidities. Importantly, DLBCL was not associated with differential AMI management or survival.</p>}},
author = {{Ekberg, S. and Harrysson, S. and Jernberg, T. and Szummer, K. and Andersson, P. O. and Jerkeman, M. and Smedby, K. E. and Eloranta, S.}},
issn = {{0954-6820}},
keywords = {{acute myocardial infarction; cardiology; epidemiology; lymphoma}},
language = {{eng}},
number = {{5}},
pages = {{1048--1060}},
publisher = {{Wiley-Blackwell}},
series = {{Journal of Internal Medicine}},
title = {{Myocardial infarction in diffuse large B-cell lymphoma patients – a population-based matched cohort study}},
url = {{http://dx.doi.org/10.1111/joim.13303}},
doi = {{10.1111/joim.13303}},
volume = {{290}},
year = {{2021}},
}