Anthracycline-induced cardiotoxicity in diffuse large B-cell lymphoma: NT-proBNP and cardiovascular score for risk stratification

Mariana Paola Ferraro, Eva Gimeno-Vazquez, Isaac Subirana, Miquel Gómez, Javier Díaz, Blanca Sánchez-González, Francesc García-Pallarols, Laia Martínez, Mireia Ble, Lluis Molina, Laia Carla Belarte, Eugenia Abella, Roberto Elosua, Josep Comín-Colet, Antonio Salar

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    10 Citations (Scopus)


    © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Objective: To evaluate the role of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and a cardiovascular (CV) risk score named FRESCO for predicting anthracycline-induced cardiotoxicity (AIC) in diffuse large B-cell lymphoma (DLBCL). Methods: A total of 130 consecutive DLBCL patients treated in first-line with anthracycline-containing immunochemotherapy. Competitive risk between NT-proBNP, FRESCO, and time to AIC was considered. Results: Cumulative incidence of AIC was 12.2% and 17.5% at 1 and 5 years, respectively. Median time to development cardiotoxicity was 6.4 months, with half of the cases showing heart failure and the other half silent AIC. Both NT-proBNP levels and FRESCO score were independently associated with higher risk of AIC (P = 0.001 and P = 0.03, respectively). Patients with NT-proBNP ≥600 pg/mL or those with FRESCO ≥4.5% had 3.97 or 2.54 times higher risk of AIC than those with lower values (P = 0.001 and P = 0.048, respectively). According to the previous cutoffs, three groups of patients with a significantly different risk of AIC could be identified (P < 0.0001). Conclusions: Doxorubicin-containing chemotherapy is associated with increased risk of silent and overt AIC. Baseline NT-proBNP levels and FRESCO CV risk score are accurate predictors of AIC and can identify groups of patients at different risk, in which personalized cardiologic evaluation should be offered.
    Original languageEnglish
    Pages (from-to)509-515
    JournalEuropean Journal of Haematology
    Publication statusPublished - 1 Jun 2019


    • anthracyclines
    • cardiotoxicity
    • heart failure
    • lymphoma
    • N-terminal pro-brain-type natriuretic peptide


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