Primary Cardioprotection Reduces Mortality in Lymphoma Patients with Increased Risk of Anthracycline Cardiotoxicity, Treated by R-CHOP Regimen.

BACKGROUND: Advances in anti-lymphoma therapy prolong overall survival, making late adverse effects, like doxorubicin-related cardiotoxicity, an even more important clinical issue. The effectiveness of cardioprotective strategies with close monitoring, angiotensin-converting enzyme inhibitors and/or ß-blockers as well as liposomal doxorubicin are still unconfirmed in clinical practice. METHODS: This study evaluated the role of a primary cardioprotection strategy in preventing cardiovascular mortality and heart failure occurrence in non-Hodgkin lymphoma (NHL) patients with a high risk of anthracycline cardiotoxicity. Thirty-five NHL patients were subjected prospectively to ramipril and/or bisoprolol at NHL diagnosis, before implementing doxorubicin-containing regimens. Additionally, patients with a diagnosis of asymptomatic/mild heart failure received the liposomal form of doxorubicin. The clinical outcome and frequency of all serious cardiac events were compared with the results in a historical cohort of 62 high-risk cases treated without primary cardioprotection. RESULTS: NHL patients with a primary cardioprotection strategy did not experience cardiovascular deaths in contrast to the retrospective control group where cardiovascular mortality was 14.5% at 3 years (p < 0.05). Primary cardioprotection also decreased the frequency of new cardiotoxicity-related clinical symptoms (2.8 vs. 24.1%; p < 0.05) and prevented the occurrence of cardiac systolic dysfunction (0 vs. 8.5%, respectively; p < 0.05). Although the study was not planned to detect any survival benefit, it demonstrated a trend towards increased response rates (complete response 82 vs. 67%; p not significant) and prolonged survival (projected 5-year overall survival 74 vs. 60%; p < 0.05) for patients treated with primary cardioprotection. CONCLUSIONS: A primary personalized cardioprotection strategy decreases the number of cardiac deaths and may potentially prolong overall survival in NHL patients with increased risk of anthracycline cardiotoxicity.

[Ocular manifestations of acute T-cell lymphoblastic leukemia in hematological remission--a case report]. / Objawy oczne ostrej bialaczki limfoblastycznej T-komórkowej w stadium remisji hematologicznej--opis przypadku.

The paper presents a case of a 60 year-old female referred to the Department of Ophthalmology and Ocular Oncology, Medical College, Jagiellonian University in Krakow with the sudden severe vision deterioration in both eyes. The patient was treated for T-cell acute lymphoblastic leukemia at the local Department of Hematology, at that time she was considered to be in hematological remission. Based on findings of clinical examination and additional tests, the patient was diagnosed with leukemic infiltration of the retina and optic nerve with secondary retinal detachment. Systemic and intrathecal chemotherapy as well as local radiotherapy to both eyes were administered. Ocular manifestations of T-cell acute lymphoblastic leukemia may develop in patients in hematological remission. Standard management of leukemic infiltrates involving the retina, choroid and optic nerve includes the intrathecal chemotherapy and lo- cal radiotherapy. Such therapy caused regression and cicatrization of the ocular infiltrates, but did not improve visual acuity in the described patient.

Premature cardiovascular mortality in lymphoma patients treated with (R)-CHOP regimen - a national multicenter study.

BACKGROUND: Premature cardiovascular mortality related to chemotherapy and occurred in lymphoma survivors before disease progression is one of significant clinical failure of modern hematology. The aim of this retrospective analysis was to evaluate early cardiovascular mortality and its predictors in patients treated with the (R)-CHOP regimen. METHODS: The study assessed 610 patients: 581 patients were treated with non-liposomal doxorubicin (cumulative dose of 337 ± 96 mg/m2), and 29 patients with liposomal non-pegylated doxorubicin (cumulative dose of 237 ± 126 mg/m2). Their present status, history of cardiovascular diseases and associated risk factors were recorded. RESULTS: The analysis identified 93 deaths (15.5%): 51 cases (55%) related to lymphoma disease progression and 28 (30%) to cardiovascular complications. Multivariate Cox analysis revealed history of previous heart diseases (HR=4.71; CI: 3.82-5.6; p<0.001), ECG rhythm abnormalities related to chemotherapy (HR=4,78; CI: 3.63-5.92; p=0,01), and lack of complete remission (HR=2.73; CI: 1.78-3.66; p=0.03), as the independent predictors for cardiovascular death. Neither decreased LVEF nor increasing cumulative dose of anthracyclines had a significant predictive value for cardiovascular prognosis. CONCLUSIONS: The study indicated that cardiovascular mortality in lymphoma patients treated with (R)-CHOP regimen is relatively high and ECG monitoring may be the most effective in cardiological risk assessment. The unfavorable outcome depended on lack of complete remission that seems to be a consequence of patients' individual susceptibility for cardiac events, which should become a purpose of further trials.

[Escalated BEACOPP as an alternative in high risk Hodgkin lymphoma]. / Eskalowany BEACOPP jako alternatywa dla ABVD w chorobie Hodgkina o wysokim ryzyku.

Hodgkin Disease is one of the common lymphoma subtypes: every year over 750 new cases are diagnosed in Poland. It is most frequent in young adults between 25 - 30 years of age. In a low risk cases prognosis is excellent, and the treatment may be limited to short chemotherapy consolidated by involved field radiotherapy. In high risk cases with a large tumor burden prognosis depends from the choice of the initial therapy. Results of 8 years experience with escalated BEACOPP in UJ CM Department of Hematology are summarized in the paper. Monitoring the early response in imaging studies, particularly in positron emission tomography, allows in the majority of cases to decrease the duration of intensive therapy, without loosing it's efficacy.

[Hematological toxicity of radioimmunotherpy with 90Y Ibritumomab]. / Toksycznosc hematologiczna radioimmunoterapii z zastosowaniem 90Y Ibritumomabu.

Radioimmunotherapy with 90Y Ibritumomabu (Zevalin, BSP) is a new method of systemic radiotherapy applicable to B-cell lymphoma patients. It may be delivered as a short outpatient procedure, with few adverse effects other than hematological toxicity. In the paper, we present length and depth of cytopenias, together with the results of additional tests performed to reveal the possible pathomechanisms, based on 102 patients treated at the University Hospital in Krakow.