Delayed anthracycline-induced cardiomyopathy – case report
Languages of publication
A 43-year-old man was admitted to the hematology department due to second recurrence of anaplastic lymphoma T-cell ALK+. Lymphoma was diagnosed 28 years earlier. The patient received COP regimen (17 cycles) and CHOP (5 cycles), radiotherapy and underwent splenectomy. He achieved complete remission at that time. Relapse of the disease was diagnosed 8 years later, which was treated with 6 cycles of chemotherapy (cytarabine, mitoxantrone, vepeside and glucocorticoids) and high-dose chemotherapy followed by hematopoietic stem cell transplantation. Second disease recurrence was found in 2013, it was anaplastic lymphoma T-cell ALK+ stage IIA by Ann Arbor. Echocardiography and myocardial perfusion scintigraphy revealed chronic heart failure NYHA class I. Angiotensin receptor antagonist (ramipril) and β-blocker (carvedilol) were recommended. The patient underwent 6 cycles of ESHAP, complete remission was reported after the second cycle. High-dose therapy with autologous stem cell rescue was considered at that time. However, having T-cell ALK+ lymphoma with a relatively good prognosis, previous prolonged complete remissions (respectively – 12 and 8 years), an insufficient yield from the harvest (3,33 × 106/kg CD34+ cells), heart failure and chronic active viral hepatitis B, the high risk intensive chemotherapy followed by hematopoietic stem cells transplantation was discontinued. The chemotherapy was complicated by brachial vein and superficial vein thrombosis of left upper limb and hypogammaglobulinemia. Follow-up echocardiography performed after completion of chemotherapy showed improvement in EF (64%).
- Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: diagnosis, pathogenesis and management. Circulation 2004; 109(25): 3122-3131.
- Limat S, Demesmay K, Voillat L et al. Early cardiotoxicity of the CHOP regimen in agressive non-Hodgkin’s lymphoma. Ann Oncol 2003; 14: 277-281.
- Hershman DL, McBride RB, Eisenberger A et al. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with Diffuse B-cell Non-Hodgin’s lymphoma. J Clin Oncol 2008; 10(26): 3159-3165.
- Aleman BM, van den Belt-Dusebout AW, De Bruin ML et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood 2007; 109(5): 1878-1886.
- Steinherz LJ, Steinherz PG, Tan CT et al. Cardiac toxicity 4 to 20 years after completing anthracycline therapy. JAMA 1991; 266: 1672-1677.
- Moser EC, Noordijk EM, van Leeuwen FE et al. Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma. Blood 2006; 107: 2912-2919.
- Felker GM, Thompson RE, Hare JM et. al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000; 342: 1077-1084.
- Bosch X, Rovira M, Sitges M et al. Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies: the OVERCOME Trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies). J Am Coll Cardiol 2013; 61(23): 2355-2362.
- Cardinale D, Colombo A, Lamantia G et al. Anthracycline-Induced Cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol 2010; 55(3): 213-220.
- Singal PK, Iliskovic N. Doxorubicin-Induced Cardiomyopathy. N Engl J Med 1998; 339(13): 900-905.
- Ewer MS, Martin FJ, Henderson C et al. Cardiac safety of liposomal anthracyclines. Semin Oncol 2004; 31(6): 161-181.
- Rafiyath SM, Rasul M, Lee B et al. Comparison of safety and toxicity of liposomal doxorubicin vs. convetional anthracyclines: a meta-analysis. Exp Hematol Oncol 2012; 1(1): 10.
- O’Brien ME, Wigler N, Inbar M et al. Reduced cardiotoxicity and comfortable efficacy in a phase III trial of pegylated doxorubicin HCI (Caelyx/ Doxil) versus convetional doxorubicin first-line treatment of metastatic breast cancer. Ann Oncol 2004; 15(3): 440-449.
- Rigacci L, Mappa S, Nassi L et al. Liposome-encapsulated doxorubicin in combination with cyclophosphamide, vincristine, prednisone and rituximab in patients with lymphoma and concurrent cardiac diseases or pre-treated with anthracyclines. Hematol Oncol 2007; 25(4): 198-203.
- Luminari S, Montanini A, Caballero D et al. Nonpegylated liposomal doxorubicin (Myocet) combination (R-COMP) chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL): results from the phase II EURO18 trial. Annals of Oncology 2009; 10: 1093.
- Heintel D, Skrabs C, Hauswirth A et al. Nonpegylated liposomal doxorubicin is highly active in patients with B and T/NK lymphomas with cardiac comorbidity or higher age. Ann Hematol 2010; 89(2): 163-169.
- Tulpule A, Espina BM, Berman N et al. Phase I/II trial of nonpegylated liposomal doxorubicin, cyclophosphamide, vincristine, and prednisone in the treatment of newly diagnosed agressive non-Hodkgkin’s lymphoma. Clinical Lymphoma Myeloma 2006; 7(1): 59-64.
- Dell’olio M, Scalzulli RP, Sanpaolo G et al. Non-pegylated liposmal doxorubicin (Myocet) in patients with poor-risk aggressive B-cell non-Hodgkin lymphoma. Leuk. Lymphoma 2011; 52(7): 1222-1229(8).
Publication order reference