Background:
Non-Hodgkin Lymphoma is the most common hematological malignant tumor, and its prevalence is increasing worldwide. It usually presents with enlarged lymph node along with other symptoms such as weight loss, night sweats, and fever collectively known as B symptoms. Medical history, physical examination, biopsy, computed tomography, magnetic resonance imaging, and PET scan all form the basis of diagnosis. Chemotherapy, radiotherapy, immunotherapy, surgery and stem cell transplantation are the various treatment options available for Non-Hodgkin Lymphoma. Among the different chemotherapeutic regimens available, the CHOP or R-CHOP regimen is the gold-standard first-line therapy for non-Hodgkin’s lymphoma. It includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone for the CHOP regimen and Rituximab in addition for the R-CHOP regimen. Cardiotoxicity caused predominantly by doxorubicin and cyclophosphamide is the major adverse effect of this regimen, which can manifest as heart failure. Early identification of cardiotoxicity can improve patient outcomes.
Aim:
This study aimed to determine the cardio toxic profile of the CHOP/R-CHOP regimen in patients with NHL in a tertiary care center in northern Kerala and to study the risk factors associated with the development of cardiotoxicity.
Methods:
This prospective observational study was conducted in patients attending the Department of Medical oncology and Hematology, in collaboration with the Departments of Pharmacology and Cardiology, Government Medical College, Kozhikode, with a diagnosis of Non-Hodgkin’s lymphoma who received CHOP/R-CHOP chemotherapy regimen for the same. A total of 55 participants were enrolled in the study according to the inclusion criteria and after obtaining informed consent. All the patients needed 6 cycles of chemotherapy which was given 3 weekly. Follow-up evaluation performed with history, physical examination, blood investigation (Random Blood Sugar – RBS, Renal Function Test - RFT), electrocardiography, and echocardiography after completing 3rd cycle and 6th cycle of chemotherapy. Reduction in ejection fraction ≥ 10 percent from baseline along with other symptoms and signs of heart failure and ECG changes were evaluated during follow-up.
Results:
The analysis was performed after completing 3rd and 6th cycle with a total of 55 participants. Only one patient (1.82%) experienced a reduction in ejection fraction ≥ 10% from baseline without any signs, symptoms, or ECG changes. Thus, it was subclinical cardiotoxicity. Various risk factors for the development of cardiotoxicity with the CHOP/R-CHOP regimen were also analyzed using Fisher’s exact test. None of the risk factors had statistical association with cardiotoxicity (P value>0.05).
Conclusion:
The cardiotoxicity of the CHOP/R-CHOP regimen in patients with NHL was low, and there were no proven associations with risk factors and cardiotoxicity.
Key words: Non-Hodgkin lymphoma, CHOP/R-CHOP, Doxorubicin, Cardiotoxicity, Ejection fraction
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