Myocardial infarction in diffuse large B‐cell lymphoma patients – a population‐based matched cohort study

• Published in: Journal of internal medicine 2021-11, Vol.290 (5), p.1048-1060
• Main Authors: Ekberg, S., Harrysson, S., Jernberg, T., Szummer, K., Andersson, P.‐O., Jerkeman, M., Smedby, K. E., Eloranta, S.
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; B-cell lymphoma; Beta cells; cancer; Cancer and Oncology; Cancer och onkologi; Cardiac and Cardiovascular Systems; cardiology; cardiotoxicity; chemotherapy; chop; Clinical Medicine; Cohort analysis; Cohort Studies; Comparators; Complications; Congestive heart failure; Diabetes mellitus; Diagnosis; doxorubicin; Drug therapy; elderly-patients; epidemiology; Female; General & Internal Medicine; Heart attacks; Heart rate; heart-disease; Humans; Hypertension; Incidence; Kardiologi; Klinisk medicin; Lymphoma; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - epidemiology; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Myocardial infarction; Myocardial Infarction - epidemiology; Patients; Population; Population studies; Population-based studies; Risk analysis; Risk Factors; rituximab; Survival; Sweden - epidemiology; toxicity
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1111/joim.13303

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.