Difficulties of preventing cardiotoxicity in patients with lymphomas and those receiving anthracyclines treatment

Abstract

Background . The percentage of short-term and long-term consequences of chemoradiation therapy and their detection increases with the increase in the survival cancer patient rate. Currently, enalapril, carvedilol, and low-dose statins are recognized as drugs that prevent cardiotoxicity from chemoradiation therapy. The work aimed to study the cardioprotective treatment tolerability in patients with lymphomas receiving chemotherapeutic treatment with the inclusion of anthracycline antibiotics. Materials and methods . We examined 47 patients with Hodgkin’s and non-Hodgkin’s lymphomas, who received treatment with chemotherapeutic agents, including anthracycline antibiotics (doxorubicin and epirubicin). Study inclusion criteria were anthracycline antibiotic use in specific treatment regimens for the underlying lymphoproliferative disease and signed informed consent. At the start of treatment and after the first cycles of chemotherapy, the indicators of electrocardiography, echocardiography, and blood pressure measurements at home with constant monitoring were assessed. And then, the general condition of the patients, the tolerability of the main and preventive treatments, and adherence to therapy were studied during the preventive treatment with carvedilol and/or enalapril. Results . Drug titration was difficult because of poor tolerability, asthenia increase, and low blood pressure, and in some cases, it led to self-withdrawal of drugs. The heart rate during preventive treatment decreased in both groups of patients, but it was statistically insignificant and did not reach the target values. This result was due to the rapid decrease in systolic blood pressure, which prevented the titration of enalapril and carvedilol to the target dosages. Conclusion . Adherence to preventive therapy throughout chemotherapy remained low. When assessing the tolerability of enalapril and carvedilol at the initial stages of titration, there were difficulties because of the rapid decrease in blood pressure before reaching the target heart rate values.