Anthracycline-related cardiotoxicity among patients with lymphoma: Systematic review and meta-analysis

e19517 Background: Anthracycline-induced cardiotoxicity (AIC) is a well-known phenomenon, but event rates and predictors may not be as robust as commonly perceived. We performed a systematic review and meta-analysis to elucidate AIC definitions, incidence rates and predictors. Methods: 5323 reports were identified via searching Medline, Embase, and Scopus. Inclusion criteria for full text review included minimum of 100 lymphoma patients receiving ACs; median/mean follow up of at least 12 months; and specified evaluation of left ventricular ejection fraction. We investigated the definition, reported incidence, and predictors of AIC including subclinical AIC as detected by decrease in left ventricular systolic dysfunction. Meta-analysis was performed with Meta-analyst software with random effects model. Results: A total of 19 studies were included in the analysis. The overall incidence of AIC in 13926 patients was 13.8% (95% CI 4.8-22.8, I2 99.6% p < 0.001) at a mean/median follow-up ranging from 1 to 8 years. Subclinical AIC was seen in 8.2% of 5464 patients (95% CI 6.4 to 10%, I2 78.9%, p < 0.001) at a mean/median follow-up ranging from 1 to 20 years. Subclinical AIC is defined in most studies as asymptomatic decrease in LVEF by 10-15% from baseline of 50-55%. Older age, increasing AC dose or number of cycles, GLS (global longitudinal strain), and prior comorbidities such as CAD, HTN, DM and dyslipidemia were found to predict AIC. However, Heterogeneity was seen in definition of AIC, risk factor assessment and follow-up protocol, which limited the extent of correlative analyses for cardiotoxicity predictors. Conclusions: The overall incidence of clinical HF and subclinical AIC among lymphoma patients was 13.8% and 8.2% respectively. Older age, increasing AC dose or number of cycles, GLS, and prior comorbidities such as CAD, HTN, DM and dyslipidemia were found to predict AIC.