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Rituximab is a recombinant, anti-CD20 antibody that has emerged in recent years as an effective therapy for non-Hodgkin's lymphoma and other B-cell malignancies. Data examining the cardiovascular toxicities of rituximab are scant, even though various cases of fulminant heart failure have been reported. Previously, a similar monoclonal antibody, trastuzumab, has been shown to have cardiotoxic properties.
We retrospectively identified patients who were treated in our cancer center after January 1, 1998 and had a baseline left ventricular ejection fraction (LVEF) of greater than 50% and no history of clinical heart failure. Cardiotoxicity was defined as a decrease in LVEF to below 50% or a hospital admission for congestive heart failure. Using a multivariable model to adjust for important baseline demographic and clinical characteristics (including cardiovascular risk factors, type of malignancy, radiation exposure, and use of other cardiotoxic agents), we examined if administration of rituximab was associated with cardiotoxicity.
Of 2350 patients meeting the inclusion parameters, 313 were treated with rituximab (243 alone and 70 in combination with other cardiotoxic agents). Among these, 12% developed low ejection fraction and/or clinical heart failure. However, when compared to patients not receiving known cardiotoxic agents, i.e. control group (N=1461), there was no significant association between rituximab and development of cardiotoxicity (HR 0.82 (95% CI 0.33-2.05), p=0.67). Furthermore, the combination of rituximab and doxorubicin was not associated with a significantly increased risk of cardiotoxicity as compared to doxorubicin administered alone, although a trend was noted (HR 2.01 (95% CI 0.9-4.53), p=0.09).
Therapy with rituximab, whether alone or in combination with doxorubicin, is not significantly associated with an increased occurrence of cardiotoxicity in cancer patients.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Dilated Cardiomyopathies: From Peripartum, Cancer Therapy, Familial Cardiomyopathies to Cardiac Amyloidosis
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1134-277
- 2013 American College of Cardiology Foundation