Cardiotoxicity as indicated by LVEF and troponin T sensitivity following two anthracycline-based regimens in lymphoma: Results from a randomized prospective clinical trial
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Kai Xue1,2,*, Juan J. Gu3,*, Qunling Zhang1,2, Xiaojian Liu1,2, Jiachen Wang1,2, Xiao-qiu Li4,2, Jianfeng Luo5,2, Francisco J. Hernandez-Ilizaliturri3, Stanley F. Fernandez6, Myron S. Czuczman3, Junning Cao1,2, Xiaonan Hong1,2, Ye Guo1,2
1Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
3Department of Medicine & Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA
4Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
5Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
6Department of Medicine, University at Buffalo, the State University of New York, Buffalo, NY, USA
*These authors have contributed equally to this work
Ye Guo, email: [email protected]
Keywords: cardiac toxicity, doxorubicin, epirubicin, high-sensitivity troponin T
Received: December 15, 2015 Accepted: March 28, 2016 Published: April 11, 2016
Anthracycline-induced cardiotoxicity influences treatment selection and may negatively affect clinical outcomes in lymphoma patients. While epirubicin induced cardiotoxicity less often than the same dose of doxorubicin in breast cancer, higher doses of epirubicin are required in lymphoma regimens for equivalent efficacy. Whether a higher dosage of epirubicin also induces cardiotoxicity less often than doxorubicin in lymphoma remains unknown. We therefore administered 6-8 cycles of cyclophosphamide, vincristine and prednisone (CEpOP) +/- rituximab (R) with either epirubicin (CEpOP) or doxorubicin (CHOP) to patients (N=398) with untreated diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma grade 3 (FLG3). Left ventricular ejection fraction (LVEF) and high-sensitivity serum cardiac troponin T (HsTnT) were assessed at baseline and after 4 cycles of treatment. Epirubicin (70 mg/m2/dose) was equivalent to doxorubicin (50 mg/m2/dose) in terms of 3-year progression-free survival. The risk of decreased LVEF was similar between the two regimens. CEpOP+/-R induced HsTnT elevation less often than CHOP+/-R. We conclude that CEpOP+/-R is a more acceptable regimen with short-term efficacy similar to CHOP+/-R in lymphoma patients. Longer follow-up is needed to monitor the risk of cardiac dysfunction and determine whether differences in the induction of elevated HsTnT between epirubicin and doxorubicin justify changes in clinical practice.
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