Impact of different types of hematologic disorders on anthracycline-induced cardiotoxicity: a retrospective analysis

Baseline stratification of cardiovascular risk in patients undergoing anthracycline chemotherapy is of critical clinical importance. To date, the specific role of different types of hematologic disorders in predicting anthracycline-induced cardiotoxicity has not been systematically evaluated.

This study aimed to assess whether specific hematologic malignancies, including Hodgkin's Lymphoma (HL), Non-Hodgkin's Lymphoma (NHL), and Acute Myeloid Leukemia (AML), are associated with differential risks of developing anthracycline-induced cardiotoxicity.

This retrospective observational study included 152 patients diagnosed with HL (n=38), NHL (n=92), and AML (n=22), treated and/or hospitalized between 2009 and 2023. All patients underwent at least one baseline echocardiographic evaluation and a follow-up echocardiographic evaluation after the first cycle of anthracycline chemotherapy, with a median follow-up of 357.85 days. The primary endpoint was post-chemotherapy cardiac dysfunction (PCCD), defined as a composite of reduced left ventricular ejection fraction (LVEF), new-onset diastolic dysfunction, or increased left ventricular end-diastolic diameter.

Of the 152 patients included, baseline characteristics, including anamnesis, anthropometric, laboratory, and echocardiographic variables, were comparable across the groups, except for age (higher in NHL patients; p=0.0016) and tricuspid annular plane systolic excursion (TAPSE, higher in AML patients; p=0.0107). Regarding antineoplastic therapies, NHL patients predominantly received CHOP or R-CHOP regimens, HL patients received ABVD, and AML patients were treated with the 3+7 protocol.

At follow-up, the primary endpoint (PCCD) was significantly more frequent in HL patients compared to NHL and AML patients (HL 71.05% vs. NHL 42.39% vs. AML 45.5%; p=0.0108). Similarly, a significant reduction in LVEF was observed in HL patients (HL 50% vs. NHL 25% vs. AML 31.82%; p=0.0213). Logistic regression analysis confirmed a strong association between HL and PCCD (OR 3.25; p=0.0035; 95% CI 1.47–7.19) as well as between HL and LVEF reduction (OR 2.80; p=0.0080; 95% CI 1.30–5.98). After adjusting for age, sex, cardiovascular risk factors, and the most frequently administered antineoplastic drugs, these associations remained statistically significant.

Patients with HL exhibit a higher risk of developing anthracycline-induced cardiotoxicity, particularly in terms of LVEF reduction, compared to NHL and AML patients. This increased susceptibility appears to be independent of baseline comorbidities and treatment regimens. Further studies are warranted to explore potential underlying mechanisms and optimize risk stratification in this population.

Differences between groups