The vast majority of lymphoma patients treated firstline with CHOP and R-CHOP are missing out on vital cardiac monitoring as recommended by international guidelines, a review has found.

The systematic review and meta-analysis of 137 studies and over 21,000 patients published in Lancet Haematology found that despite the well established association of doxorubicin with left ventricular dysfunction, cardiac systolic function was assessed after treatment in only 10 percent of the studies.

The incidence of heart failure increased from 1.64% to 11.72% (p=0.017) in the studies implementing cardiac monitoring of asymptomatic patients.

“The considerable increase of reported heart failures with cardiac monitoring indicates that this complication often remains undiagnosed in patients  with non-Hodgkin lymphoma,” the study authors wrote.

Over 65s and female gender were identified in the review as being at particularly high-risk of severe cardiovascular complications.

“Clinicians should be aware that chemotherapy-related cardiac dysfunction is common after treatment with CHOP or R-CHOP and often does not immediately result in symptomatic heart failure,” the authors concluded.

According to an accompanying editorial, the take home message from the review was for haemato-oncologists to include a dedicated cardiologist in their lymphoma teams.

“In the absence of detailed guidelines, an individualised approach to every patient is necessary to find the balance between toxicity and efficacy of the therapy.

The better the prognosis of patients with lymphoma and the longer their median overall survival , the more important the role of cardiovascular monitoring. Unrecognised and untreated cardiac dysfunction might both decrease the quality and quantity of a patient’s life,” they concluded.