Hematol Oncol:诊断为弥漫性大 B 细胞淋巴瘤并接受蒽环类药物治疗的患者心血管事件和死亡率的危险因素

2022-07-06 网络 网络

老年患者、糖尿病患者和疾病晚期患者发生CVE的风险最高,后续研究应重点关注这些高危患者群体中这一常见并发症的监测和预防措施

弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者在接受基于蒽环类药物的化疗后发生充血性心力衰竭 (CHF) 的风险增加。但目前关于 CHF 的危险因素、其他心血管事件 (CVE) 和 CVE 对结果的影响的报道较少。因此,一研究团队对 2002 年至 2016 年间接受含蒽环类药物治疗的 463 名新诊断的 DLBCL 患者进行了回顾性研究,旨在描述使用含蒽环类药物方案治疗的DLBCL患者的临床特征和结果。

图1:按肿瘤分期(晚期与早期)划分的心血管事件累积发生率(CVE)(以死亡作为竞争风险)的估计值。早期患者与晚期患者的累积发生率(曲线)差异有统计学意义(p=0.026)

在中位随访 71.3 个月时,10.4% 的患者出现新的 CHF,4.97% 的患者出现新的心房颤动,3.2% 的患者出现新的冠状动脉疾病。65 岁以上、晚期 DLBCL 和糖尿病与 CVE 累积发病率增加相关。

图2:比较糖尿病患者和非糖尿病患者的心血管事件累积发生率(CVE)(以死亡作为竞争风险)的估计值。糖尿病患者与非糖尿病患者的累积发生率(曲线)差异有统计学意义(p=0.0013)

图3:KaplanMeier估计心血管事件(CVE)1年的总生存期(OS)(1年有CVE,1年没有CVE)。CVE患者到第1年的中位(95%CI)OS为10.4个月(8.6,13.1)个月。第1年无CVE患者的中位(95%CI)OS为162.6个月(156.7月,未达到)

与非糖尿病患者相比,既往糖尿病患者的无进展生存期和总生存期降低。第一年发生 CVE 的患者的 OS 明显低于没有 CVE 的患者(风险比 10.0,95% CI,7.24-13.88)。

图4:KaplanMeier对淋巴瘤诊断后第一年内新发充血性心力衰竭(CVE_CHF)状态的总生存率的估计

图5:根据最终建立的模型和风险评分公式,比较低风险患者和高危患者的心血管事件累积发生率(CVE)(以死亡为竞争风险)的估计值。低危组、中、高危组患者的累积发生率(曲线)差异有统计学意义(p=0.0014)

将 DLBCL 诊断时的年龄、基线淋巴细胞计数、疾病分期和糖尿病分为 CVE 低、中和高风险组,1 年 CVE 累积发生率分别为 5.3%、7.9% 和 13.4%。接受含蒽环类药物治疗的弥漫性大 B 细胞淋巴瘤患者 CVE 发生率较高,不仅限于 CHF。

图6:白蛋白、RDW、ECOG PS和分期之间的斯皮尔曼相关矩阵。任何成对之间的相关性均有统计学意义(p值<0.0001)

研究发现晚期疾病和糖尿病都与更严重的OS显著相关,同时强调了心血管预后对在DLBCL诊断后生存的影响。这是第一个关于糖尿病影响北美患者DLBCL预后的报告,并强调了心血管护理和监测对改善DLBCL生存率的相关性。老年患者、糖尿病患者和疾病晚期患者发生CVE的风险最高,后续研究应重点关注这些高危患者群体中这一常见并发症的监测和预防措施

 

原始出处:

Diamond, AAyyappan, SCao, S, et al. Risk factors for cardiovascular events and mortality in patients diagnosed with diffuse large B-cell lymphoma and treated with anthracyclinesHematol Oncol2022111. https://doi.org/10.1002/hon.3034.

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    2022-07-07 fengyi812
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    2022-07-07 zhouqu_8
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    2022-07-06 jing0309

    感谢分享

    0

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