Exposure to doxorubicin during chemotherapy treatment for diffuse large B-cell lymphoma (DLBCL) was associated with an increased risk for developing cardiovascular diseases (CVDs) among Asian patients, found a population-based study in Blood Advances.

Using an electronic medical database in Hong Kong known as the Clinical Data Analysis and Reporting System (CDARS), study researchers obtained data on patients who received a diagnosis of DLBCL and were treated with chemotherapy between 2000 and 2018.

The study included 2600 patients who received chemotherapy, 865 of whom received a doxorubicin-containing regimen and 1735 whom received a doxorubicin-free regimen. A control group of 13,000 individuals who had no history of cancer or CVD were age- and sex-matched to patients.

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A multivariate analysis revealed a 2.5-fold increased risk for CVD for patients exposed to a more than 500 mg absolute dose of doxorubicin compared with patients who were treated with a doxorubicin-free regimen (adjusted cause-specific hazard ratio [HR], 2.55; 95% CI, 1.18-5.53; P =.017).

Patients exposed to a more than 500 mg absolute dose of doxorubicin had a cause-specific cumulative incidence (csCI) of CVD of 8% at 5 years, 11.1% at 10 years, and 12. 5% at 15 years, which were higher than the csCI seen in the doxorubicin-free regimen group (3.8%, 5.6%, and 6.5%, respectively) and control group (3.1%, 4.4%, and 5.2%, respectively).

Risk of CVD was particularly high among patients who at baseline had hypertension (HR, 6.21; 95% CI, 0.80-48.43; P =.081) or used aspirin (HR, 4.63; 95% CI, 2.54-8.43; P <.001), ACE inhibitors (HR, 2.13; 95% CI, 1.32-3.42; P =.002), or beta blockers (HR, 2.18; 95% CI, 2.54-8.43; P <.001).

The analysis also revealed that most CVDs were detected within a median of approximately 4 years after treatment, which according to the study authors supports recommendations of cardiac evaluation early after treatment, such as those from the American Society of Clinical Oncology Clinical Practice Guidelines.

“We propose that the follow-up of patients in this period by oncologists and primary care physicians should focus not only on disease relapse but also on the evaluation for and prompt treatment of cardiac risk factors, with cardiac screening of asymptomatic patients,” the study authors wrote.


Lee SF, Luque-Fernandez MA, Chen YH, et al. Doxorubicin and subsequent risk of cardiovascular diseases among survivors of diffuse large B-cell lymphoma in Hong Kong. Blood Adv. 2020;4(20):5107-5117. doi:10.1182/bloodadvances.2020002737