Therapy-associated subclinical cardiac injury in survivors of Hodgkin and non-Hodgkin lymphoma.

Abstract

e19572 Background: Contributions of modern techniques of mediastinal radiation (mRT) and anthracycline chemotherapy (ACT) to cardiotoxicity in survivors of Hodgkin (HL) and Non-Hodgkin lymphoma (NHL) remain incompletely defined. We assessed the effects of mRT and / or ACT on subclinical cardiotoxicity by radionuclide imaging. Methods: 100 HL and NHL survivors without cardiac symptomatology were screened with ECG-gated RN perfusion and ventriculographic scans since 8/91. In this analysis we reviewed the most recent scan (mean 10.9 ± .06 yrs, median 8.1 yrs). Treatment groups included: ACT (n = 10), ACT + mRT (n = 35) and mRT (n = 55). 34 pts. had multiple gated acquisition (MUGA) scans evaluating left ventricular ejection fraction (LVEF), while 66 had ECG-gated single photon emission computed tomography (SPECT) scans evaluating myocardial ischemia, LVEF, end systolic and end diastolic volume indices (ESVI & EDVI). Since sequential blocking of the heart is often employed in modern mRT treatments, mRT dose was determined to the region of the LV (RT lv), base (RT b), and superior heart (RT sup) in addition to maximum mRT dose (maxd). Results: Mean LVEF differed among the treatment groups: ACT = 53%, ACT + mRT = 56% and mRT = 60% (n = 100, p =.015). Mean ESVI was 39, 34, 25 respectively (n = 66, p =.005). Mean EDVI was 75, 72, 59 (n = 66, p =.009). Univariate linear regression individually tested the associations between ACT, RT lv, RT b, RT sup, maxd and the cardiac variables. ACT dose was associated with reduced LVEF (n = 100, p =.04), increased ESVI (n = 66, p =.002) and increased EDVI (n = 66, p =.005). XRT doses showed no correlation. In the ACT + mRT patients, separate multivariate analysis individually tested the maxd, RT lv, RT b, RT sup with ACT dose. The only significant association was between ACT and increased EDVI, ESVI found on all analyses. No associations were seen with myocardial ischemia throughout Conclusions: Radionuclide function variables identify subclinical cardiac changes in HL and NHL survivors treated with ACT. The volume indices ESVI and EDVI appear particularly sensitive indicators of subclinical cardiac damage after ACT. Modern mRT is less correlated with subclinical cardiotoxicity as determined by LVEF, ESVI and EDVI. No significant financial relationships to disclose.