Authors: Christian Johannes Schmitt Sascha Dietrich Antony Dick Ho Mathias WitzensHarig
Publish Date: 2011/08/18
Volume: 91, Issue: 3, Pages: 391-397
Abstract
Anthracyclines are a major component in the therapy of nonHodgkins lymphoma However due to their cardiac toxicity potential curative and palliative treatment is often limited in patients with preexisting cardiac dysfunction Liposomal doxorubicin formulations have been described to be less cardiotoxic than conventional doxorubicin In the current study we analyzed the efficacy and toxicity of pegylated liposomal doxorubicin PLD as constituent of the cyclophosphamide doxorubicin vincristine and prednisone CHOP regimen replacing conventional doxorubicin in 21 patients with impaired cardiac left ventricular ejection fraction or preexisting cardiac risk factors and established diagnosis of diffuse large B cell lymphoma n = 15 mantle cell lymphoma n = 3 follicular lymphoma n = 1 and T cell lymphoma n = 2 Overall and complete response rate were 85 and 40 respectively Eventfree survival and overall survival after 2 years were 58 One lethal event of acute cardiac death occurred during the first cycle in a patient with transposition of the big arteries atrial flutter and mitral valve regurgitation In the remaining 20 patients no deterioration of myocardial function was observed in echocardiography performed before and after treatment Seven cases of grade III–IV hematological toxicity were observed as well as four episodes of neutropenic fever leading to hospitalization No infectionrelated death occurred However 25 of patients developed a hand–foot syndrome HFS leading to discontinuation of treatment Importantly the incidence of HFS increased considerably when PLD doses of 15 mg/m2/week were exceeded We conclude that replacing conventional doxorubicin with PLD in polychemotherapy regimens such as CHOP is an efficient alternative in the treatment of patients with preexisting cardiac dysfunction However we recommend that PLD dose should not exceed 15 mg/m2/week The rationale for the use of nonpegylated liposomal doxorubicin formulations should be evaluated in further studies
Keywords: