Effect of cyclophospamide, doxorubicin, vincristine and prednisone/prednisolone (CHOP) chemotherapy regimens on left ventricular systolic function and cardiac structural abnormalities in non-Hodgkin lymphoma patients.

Background: The cyclophospamide, doxorubicin, vincristine, and prednisone/prednisolone (CHOP) regimen, a standard treatment for aggressive non-Hodgkin lymphoma (NHL), is effective but linked to chemotherapy-induced cardiotoxicity (CDIC), such as heart failure and left ventricular dysfunction. Anthracyclines like doxorubicin are key contributors to CDIC. This study examines left ventricular dysfunction and structural abnormalities in NHL patients receiving CHOP therapy with cumulative doxorubicin doses ≥ 250 mg/m², aiming to improve early CDIC detection and guide timely cardioprotective interventions.

Methods: This prospective cohort study was conducted at Dr. Soetomo Regional General Hospital, Surabaya, from June to October 2023. We included NHL patients aged 18-60 years at any stage, treated with CHOP regimens containing cumulative doxorubicin doses ≥ 250 mg/m², who completed at least four chemotherapy cycles, had baseline left ventricular ejection fraction (LVEF) ≥ 50%, and good echocardiographic window quality. Data were collected from medical records, biochemical tests, and echocardiography. Wilcoxon and paired T-tests were used for statistical analyses. The primary outcome was cardiac function, evaluated by reductions in LVEF, increased left ventricular strain, new structural abnormalities, and elevated high-sensitivity (HS) troponin and NT-proBNP levels post-chemotherapy.

Results: A total of 32 patients, aged 46.62 ± 16.64 years, were included, with the colli region and stage 2 NHL being the most common. Significant differences were observed in all parameters between pre- and post-chemotherapy. LVEF decreased by - 2.40% ± 1.79 (p < 0.001), while global longitudinal strain (GLS) declined by 2.25 ± 1.36 (p < 0.001). HS troponin I levels showed a significant increase of 17.27 ± 36.29 (p < 0.001), and NT-proBNP levels rose by 321.23 ± 85.34 (p < 0.001). The study also identified a higher risk of cardiotoxicity in patients over 50 years of age.

Conclusion: The CHOP regimen poses significant risks of subclinical cardiac dysfunction and structural abnormalities in NHL patients, with cumulative doxorubicin dosage being a key contributor. Early detection using sensitive biomarkers like GLS and NT-proBNP is crucial for identifying cardiotoxicity and enabling timely interventions.