The rate of cardiac-specific mortality (CSM) was analyzed in patients with stage I and II diffuse large B-cell lymphoma diagnosed between 1988 and 2004 by querying the National Cancer Institute Surveillance, Epidemiology, and End-Results database. Analyzable data included gender, age, race, stage, presence of extranodal disease, and RT administration.
A total of 15,454 patients met selection criteria; 6,021 (39 % ) patients received RT. The median follow-up was 36 months (range, 6–180 months). The median age was 64 years. The actuarial incidence rates of CSM at 5, 10, and 15 years were 4.3 % , 9.0 % , and 13.8 % , respectively, in patients treated with RT vs. 5.9 % , 10.8 % and 16.1 % , respectively, in patients treated without RT (p < 0.0001; hazard ratio, 1.35; 95 % confidence interval [CI]: 1.16–1.56). The increase in cardiac deaths for patients treated without RT persisted throughout the follow-up period. On multivariate analysis, treatment without RT remained independently associated with an increased risk of CSM (Cox hazard ratio, 1.32; 95 % CI: 1.13–1.54; p = 0.0005).
Increased anthracycline exposure in patients treated only with chemotherapy regimens may result in an increase in cardiac deaths, detectable only through analysis of large sample sizes. Confirmatory evaluation through meta-analysis of randomized data and design of large prospective trials is warranted.