Higher Mortality in Patients With Diffuse Large B-cell Lymphoma Pre-Existing Arterial Hypertension-Real World Data of the Polish Lymphoma Research Group

Sebastian Szmit; Monika Długosz-Danecka; Joanna Drozd-Sokołowska; Monika Joks; Agnieszka Szeremet; Artur Jurczyszyn; Wojciech Jurczak

doi:10.1016/j.hlc.2024.03.003

Higher Mortality in Patients With Diffuse Large B-cell Lymphoma Pre-Existing Arterial Hypertension-Real World Data of the Polish Lymphoma Research Group

Heart Lung Circ. 2024 Apr 13:S1443-9506(24)00157-4. doi: 10.1016/j.hlc.2024.03.003. Online ahead of print.

Authors

Sebastian Szmit¹, Monika Długosz-Danecka², Joanna Drozd-Sokołowska³, Monika Joks⁴, Agnieszka Szeremet⁵, Artur Jurczyszyn⁶, Wojciech Jurczak²

Affiliations

¹ Department of Cardio-Oncology, Chair of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Institute of Hematology and Transfusion Medicine, Warsaw, Poland. Electronic address: s.szmit@gmail.com.
² Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland.
³ Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
⁴ Department of Hematology, University of Medical Sciences, Poznań, Poland.
⁵ Department of Hematology, Wrocław Medical University, Wrocław, Poland.
⁶ Plasma Cell Dyscrasia Center, Department of Hematology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.

PMID: 38616466
DOI: 10.1016/j.hlc.2024.03.003

Abstract

Background: Arterial hypertension is mentioned as a risk factor in Cardio-oncology. This study aimed to assess the long-term prognostic value of arterial hypertension (AH) in diffuse large B-cell lymphoma (DLBCL).

Methods: We analysed data collected by the Polish Lymphoma Research Group for the evaluation of the outcomes associated with the use of first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone therapy in patients with DLBCL with coexisting AH. Patients with other cardiovascular comorbidities or premature chemotherapy discontinuation due to cardiovascular toxicity were excluded.

Results: Pre-existing AH was diagnosed in 65 of 232 patients with DLBCL (28%) included in the study, and was associated with significantly shorter overall survival values (p<0.00001). The rates of DLBCL recurrence, administration of second-, third-, or fourth-line chemotherapy, and lymphoma-related deaths were similar in patients with and those without AH. Cardiovascular deaths were significantly more frequently observed in patients with pre-existing AH (38.5% vs 3.6%, p<0.0001). In the univariate analysis, AH (p=0.000001), older age (p<0.000001), and diabetes (p=0.0065) were identified as significant predictors of all-cause mortality; however, cardiovascular mortality was associated with AH (p<0.000001), older age (p=0.000008), and dyslipidaemia (p=0.03). Multivariate analysis revealed AH as an age-independent significant predictor of all-cause (p=0.00045) and cardiovascular mortality (p<0.000001).

Conclusion: In the long-term follow-up of patients with DLBCL, the role of AH, as an important age-independent predictor of premature cardiovascular mortality, was so strong that it may have value for use in close surveillance in cardio-oncology clinics.

Keywords: Arterial hypertension; Cardio-oncology; Cardiotoxicity; Diffuse large B-cell lymphoma; Mortality; Outcomes.

Copyright © 2024 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.