The Effect of Prophylactic Antihypertensives on the Incidence of Anthracycline-Induced Cardiomyopathy in Patients with Diffuse Large B Cell Lymphoma
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- Category: Vol. 84, December 2016
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The Effect of Prophylactic Antihypertensives on the Incidence of Anthracycline-Induced Cardiomyopathy in Patients with Diffuse Large B Cell Lymphoma, HAMDY M. ZAWAM, MENNAT ALLAH M.M. ABDELRADI, EMAD M. HAMMADA and YASER M. BAGHDADY
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). The standard of care for initial treatment of DLBCL is ritux-imab, cyclophosphamide, doxorubicin, vincristine, and pred-nisone on a 21-day schedule (R-CHOP21) for six cycles. Anthracyclines (or anthracycline antibiotics) are a class of dugs described as being cell-cycle non specific chemotherapy. They have been used as efficacious antineoplastic agents for many haemopoietic (Lymphomas. Leukemias) and solid cancers as in breast cancer. The heart is especially susceptible to anthracycline-induced damage, in part, owing to anthracy-clines' high affinity for cardiolipin. Prophylactic use of antihypertensives to prevent anthracycline-induced cardiomy-opathy has been utilized in several studies. Our study aims to assess the effect of prophylactic use of antihypertensives in prevention of doxorubicin induced cardiotoxicity.
Methods: Randomized trial of 50 adult patients with DLBCL conducted at Kasr Al-Ainy Oncology Department, ages 18-65 years DLBCL receiving doxorubicin based regimen presented at Kasr Al-Ainy Clinical Oncology Department during the period May 2013 till September 2014. They were randomly divided into 2 groups. Twenty four patients received prophylactic Enalapril and carvidolol with adjusted doses to their blood pressure.
Results: Fifty patients were enrolled between May 2013 and September 2014. At six month follow-up, cardiac re-assessment of 49 patients was done (1 patients died). Troponins levels were normal, the mean ejection fraction of the anti hypertensive group was similar to the baseline ejection fraction (64.7% vs. 64.3%), however, the control group ejection fraction was significantly lower (66.56% vs. 53.92%; p=0.001).
Conclusion: The use of prophylactic carvidolol and enal-april can reduce the risk of the development of anthracycline induced cardiomyopathy.