PROGNOSTIC ROLE OF NTPROBNP LEVELS AT DIAGNOSIS IN ELDERLY PATIENTS WITH DIFFUSE LARGE B CELL LYMPHOMA (DLBCL)
(Abstract release date: 05/19/16)
EHA Library. Bozzoli V. 06/09/16; 134601; PB1701
Dr. Valentina Bozzoli
Contributions
Contributions
Abstract
Abstract: PB1701
Type: Publication Only
Background
Immunochemotherapy using the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubcin, Vincristine and Prednisolone) represents the standard treatment of elderly patients (pts) with Diffuse Large B Cell Lymphoma (DLBCL), but treatment can be complicated by cardiac side effects often attributed to the cytotoxic drug doxorubicin. NTproBNP levels in plasma are typically increased in patients with left ventricular dysfunction and have been proposed as a marker for cardiac injury during cytotoxic treatment.
Aims
The aim of this study was to investigate the prognostic role of NTproBNP at diagnosis in elderly DLBCL pts.
Methods
We conducted a retrospective analysis, including 130 elderly (≥65 years) pts, median age 74 years (range 65-91), diagnosed with DLBCL from 2009 to 2014 in our institution for whom NTproBNP levels at diagnosis were available. The impact of NTproBNP levels on response and survival was evaluated in 126 patients who either received anthracycline-containing immunchemotherapy (92 pts) or immunochemotherapy without anthracyclines (34 pts). Anthracycline consisted in standard doxorubicin in 52 pts and liposomal doxorubicin in 40 pts.
Results
At diagnosis, 82/130 pts (63%) showed elevated NTproBNP levels. NTproBNP levels correlated positively with age (p=0.0001), and creatinine values (p=0.001) and negatively with levels of albumin (p=0.0001), and hemoglobin (p=0.0001). Poor performance status (ECOG ≥2) was associated with higher levels of NTproBNP (p=0.0004). Pts with a previous history of hypertension and ischemic heart disease had increased NTproBNP levels (p=0.006, and p=0.02, respectively). There was no correlation between NTproBNP and left ventricular ejection fraction at diagnosis (Spearman’s rank coefficient p=0.7, ps=-0.05). In a multivariate analysis, albumin levels <4 g/dl retained the significant association with elevated NTproBNP levels (p=0.004).Patients with normal NTproBNP levels at diagnosis had a higher probability of complete responses (91 vs 70%, p=0.02). Higher NTproBNP levels were associated with inferior event-free and overall survival both in univariate (p<0.001) and multivariate analysis including IPI and anthracycline-containing chemotherapy as significant parameters (Table I).
Conclusion
NTproBNP levels at DLBCL diagnosis are frequently elevated in elderly patients with DLBCL, predict poor outcome and are associated with a number of patient characteristics reflecting “host-related factors”, such as age, history of cardiac injury, performance status and laboratory abnormalities as low hemoglobin and albumin values. Studies on mechanisms that lead to increased NTproBNP levels in addition to wall stress on myocardiocytes are warranted.
Session topic: E-poster
Keyword(s): DLBCL, Doxorubicin, Elderly
Type: Publication Only
Background
Immunochemotherapy using the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubcin, Vincristine and Prednisolone) represents the standard treatment of elderly patients (pts) with Diffuse Large B Cell Lymphoma (DLBCL), but treatment can be complicated by cardiac side effects often attributed to the cytotoxic drug doxorubicin. NTproBNP levels in plasma are typically increased in patients with left ventricular dysfunction and have been proposed as a marker for cardiac injury during cytotoxic treatment.
Aims
The aim of this study was to investigate the prognostic role of NTproBNP at diagnosis in elderly DLBCL pts.
Methods
We conducted a retrospective analysis, including 130 elderly (≥65 years) pts, median age 74 years (range 65-91), diagnosed with DLBCL from 2009 to 2014 in our institution for whom NTproBNP levels at diagnosis were available. The impact of NTproBNP levels on response and survival was evaluated in 126 patients who either received anthracycline-containing immunchemotherapy (92 pts) or immunochemotherapy without anthracyclines (34 pts). Anthracycline consisted in standard doxorubicin in 52 pts and liposomal doxorubicin in 40 pts.
Results
At diagnosis, 82/130 pts (63%) showed elevated NTproBNP levels. NTproBNP levels correlated positively with age (p=0.0001), and creatinine values (p=0.001) and negatively with levels of albumin (p=0.0001), and hemoglobin (p=0.0001). Poor performance status (ECOG ≥2) was associated with higher levels of NTproBNP (p=0.0004). Pts with a previous history of hypertension and ischemic heart disease had increased NTproBNP levels (p=0.006, and p=0.02, respectively). There was no correlation between NTproBNP and left ventricular ejection fraction at diagnosis (Spearman’s rank coefficient p=0.7, ps=-0.05). In a multivariate analysis, albumin levels <4 g/dl retained the significant association with elevated NTproBNP levels (p=0.004).Patients with normal NTproBNP levels at diagnosis had a higher probability of complete responses (91 vs 70%, p=0.02). Higher NTproBNP levels were associated with inferior event-free and overall survival both in univariate (p<0.001) and multivariate analysis including IPI and anthracycline-containing chemotherapy as significant parameters (Table I).
Conclusion
NTproBNP levels at DLBCL diagnosis are frequently elevated in elderly patients with DLBCL, predict poor outcome and are associated with a number of patient characteristics reflecting “host-related factors”, such as age, history of cardiac injury, performance status and laboratory abnormalities as low hemoglobin and albumin values. Studies on mechanisms that lead to increased NTproBNP levels in addition to wall stress on myocardiocytes are warranted.
Session topic: E-poster
Keyword(s): DLBCL, Doxorubicin, Elderly
Abstract: PB1701
Type: Publication Only
Background
Immunochemotherapy using the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubcin, Vincristine and Prednisolone) represents the standard treatment of elderly patients (pts) with Diffuse Large B Cell Lymphoma (DLBCL), but treatment can be complicated by cardiac side effects often attributed to the cytotoxic drug doxorubicin. NTproBNP levels in plasma are typically increased in patients with left ventricular dysfunction and have been proposed as a marker for cardiac injury during cytotoxic treatment.
Aims
The aim of this study was to investigate the prognostic role of NTproBNP at diagnosis in elderly DLBCL pts.
Methods
We conducted a retrospective analysis, including 130 elderly (≥65 years) pts, median age 74 years (range 65-91), diagnosed with DLBCL from 2009 to 2014 in our institution for whom NTproBNP levels at diagnosis were available. The impact of NTproBNP levels on response and survival was evaluated in 126 patients who either received anthracycline-containing immunchemotherapy (92 pts) or immunochemotherapy without anthracyclines (34 pts). Anthracycline consisted in standard doxorubicin in 52 pts and liposomal doxorubicin in 40 pts.
Results
At diagnosis, 82/130 pts (63%) showed elevated NTproBNP levels. NTproBNP levels correlated positively with age (p=0.0001), and creatinine values (p=0.001) and negatively with levels of albumin (p=0.0001), and hemoglobin (p=0.0001). Poor performance status (ECOG ≥2) was associated with higher levels of NTproBNP (p=0.0004). Pts with a previous history of hypertension and ischemic heart disease had increased NTproBNP levels (p=0.006, and p=0.02, respectively). There was no correlation between NTproBNP and left ventricular ejection fraction at diagnosis (Spearman’s rank coefficient p=0.7, ps=-0.05). In a multivariate analysis, albumin levels <4 g/dl retained the significant association with elevated NTproBNP levels (p=0.004).Patients with normal NTproBNP levels at diagnosis had a higher probability of complete responses (91 vs 70%, p=0.02). Higher NTproBNP levels were associated with inferior event-free and overall survival both in univariate (p<0.001) and multivariate analysis including IPI and anthracycline-containing chemotherapy as significant parameters (Table I).
Conclusion
NTproBNP levels at DLBCL diagnosis are frequently elevated in elderly patients with DLBCL, predict poor outcome and are associated with a number of patient characteristics reflecting “host-related factors”, such as age, history of cardiac injury, performance status and laboratory abnormalities as low hemoglobin and albumin values. Studies on mechanisms that lead to increased NTproBNP levels in addition to wall stress on myocardiocytes are warranted.
Session topic: E-poster
Keyword(s): DLBCL, Doxorubicin, Elderly
Type: Publication Only
Background
Immunochemotherapy using the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubcin, Vincristine and Prednisolone) represents the standard treatment of elderly patients (pts) with Diffuse Large B Cell Lymphoma (DLBCL), but treatment can be complicated by cardiac side effects often attributed to the cytotoxic drug doxorubicin. NTproBNP levels in plasma are typically increased in patients with left ventricular dysfunction and have been proposed as a marker for cardiac injury during cytotoxic treatment.
Aims
The aim of this study was to investigate the prognostic role of NTproBNP at diagnosis in elderly DLBCL pts.
Methods
We conducted a retrospective analysis, including 130 elderly (≥65 years) pts, median age 74 years (range 65-91), diagnosed with DLBCL from 2009 to 2014 in our institution for whom NTproBNP levels at diagnosis were available. The impact of NTproBNP levels on response and survival was evaluated in 126 patients who either received anthracycline-containing immunchemotherapy (92 pts) or immunochemotherapy without anthracyclines (34 pts). Anthracycline consisted in standard doxorubicin in 52 pts and liposomal doxorubicin in 40 pts.
Results
At diagnosis, 82/130 pts (63%) showed elevated NTproBNP levels. NTproBNP levels correlated positively with age (p=0.0001), and creatinine values (p=0.001) and negatively with levels of albumin (p=0.0001), and hemoglobin (p=0.0001). Poor performance status (ECOG ≥2) was associated with higher levels of NTproBNP (p=0.0004). Pts with a previous history of hypertension and ischemic heart disease had increased NTproBNP levels (p=0.006, and p=0.02, respectively). There was no correlation between NTproBNP and left ventricular ejection fraction at diagnosis (Spearman’s rank coefficient p=0.7, ps=-0.05). In a multivariate analysis, albumin levels <4 g/dl retained the significant association with elevated NTproBNP levels (p=0.004).Patients with normal NTproBNP levels at diagnosis had a higher probability of complete responses (91 vs 70%, p=0.02). Higher NTproBNP levels were associated with inferior event-free and overall survival both in univariate (p<0.001) and multivariate analysis including IPI and anthracycline-containing chemotherapy as significant parameters (Table I).
Conclusion
NTproBNP levels at DLBCL diagnosis are frequently elevated in elderly patients with DLBCL, predict poor outcome and are associated with a number of patient characteristics reflecting “host-related factors”, such as age, history of cardiac injury, performance status and laboratory abnormalities as low hemoglobin and albumin values. Studies on mechanisms that lead to increased NTproBNP levels in addition to wall stress on myocardiocytes are warranted.
Session topic: E-poster
Keyword(s): DLBCL, Doxorubicin, Elderly
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