In a study reported in JACC: CardioOncology, Upshaw et al found that preexisting heart failure was associated with an increased risk of lymphoma and cardiovascular mortality among patients aged ≥ 65 years who were newly diagnosed with Hodgkin lymphoma.
The study used linked Surveillance, Epidemiology, and End Results and Medicare data from 1999 to 2016 to identify patients aged ≥ 65 years with newly diagnosed Hodgkin lymphoma.
Key Findings
Among 3,348 patients (mean age = 76 ±7 years) included in the analysis, 437 (13.1%) had preexisting heart failure. In an analysis adjusted for other comorbidities, patients with preexisting heart failure had a greater risk for lymphoma mortality (hazard ratio [HR] = 1.25, 95% confidence interval [CI] = 1.06–1.46) and cardiovascular mortality (HR = 2.57, 95% CI = 1.96–3.36) vs patients without preexisting heart failure. For patients with vs without preexisting heart failure, the cumulative incidence of lymphoma mortality was 37.4% vs 26.3% at 1 year and 46.7% vs 35.9% at 5 years. The cumulative incidence of cardiovascular morality was 7.9% vs 2.9% at 1 year and 14.5% vs 6.8% at 5 years.
Preexisting heart failure was associated with a reduced likelihood of treatment with anthracycline-based chemotherapy (odds ratio [OR] = 0.42, 95% CI = 0.29–0.60). Among patients with preexisting heart failure who received chemotherapy, those who received anthracycline-based chemotherapy had a reduced risk of lymphoma mortality vs those who received nonanthracycline treatment (HR = 0.44, 95% CI = 0.28–0.71). No significant benefit in cardiovascular mortality was observed with the use of anthracycline-based vs nonanthracycline treatment (HR = 0.62, 95% CI = 0.33–1.15).
The investigators concluded, “Preexisting heart failure in older patients with newly diagnosed Hodgkin lymphoma is common and associated with higher 1-year mortality. Strategies are needed to improve lymphoma and cardiovascular outcomes in this high-risk population.”
Jenica N. Upshaw, MD, of the Division of Cardiology, Tufts Medical Center, Boston, is the corresponding author for the JACC:CardioOncology article.
Disclosure: The study was supported by the National Institutes of Health. For full disclosures of the study authors, visit jacc.org.
