Cardiovascular diseases after high‐dose chemotherapy and autologous stem cell transplant for lymphoma: A Danish population‐based study

Abstract

SummaryCardiovascular diseases, especially congestive heart failure (CHF), are known complications of anthracyclines, but the risk for patients undergoing high‐dose chemotherapy and autologous stem cell transplant (HDT‐ASCT) is not well established. With T‐cell therapies emerging as alternatives, studies of long‐term complications after HDT‐ASCT are warranted. Danish patients treated with HDT‐ASCT for aggressive lymphoma between 2001 and 2017 were matched 1:5 on sex, birth year and Charlson comorbidity score to the general population. Events were captured using nationwide registers. A total of 787 patients treated with HDT‐ASCT were identified. Median follow‐up was 7.6 years. The risk of CHF was significantly increased in the HDT‐ASCT population compared to matched comparators with an adjusted hazard ratio (HR) of 5.5 (3.8–8.1). The 10‐year cumulative incidence of CHF was 8.0% versus 2.0% (p < 0.001). Male sex, ≥2 lines of therapy, hypertension and cumulative anthracycline dose (≥300 mg/m2) were risk factors for CHF. In a separate cohort of 4089 lymphoma patients, HDT‐ASCT was also significantly associated with increased risk of CHF (adjusted HR of 2.6 [1.8–3.8]) when analysed as a time‐dependent exposure. HDT‐ASCT also increased the risk of other cardiac diseases. These findings are applicable for the benefit/risk assessment of HDT‐ASCT versus novel therapies.