A group of specialists from the Carlos III National Center for Cardiovascular Research (CNIC) has led a study that questions the appropriateness of applying the same strategy of intensive cardiac monitoring to all patients with lymphoma receiving anthracyclines, and proposes to adjust the monitoring to the individual risk profile.
Anthracyclines continue to be a therapeutic pillar in various hematological cancers, especially in lymphomas. However, their use can cause cardiac toxicity, which is why clinical guidelines recommend close cardiovascular monitoring during and after chemotherapy.
The CNIC recalls in a note that a good part of these recommendations is based on expert consensus and that there is limited data on their true utility in people with low or intermediate cardiovascular risk.
In this scenario, the study, published in the journal "JACC: CardioOncology," was designed to clarify whether intensive cardiac monitoring provides truly relevant information in patients with low risk of cardiotoxicity. To this end, 44 individuals with a recent diagnosis of lymphoma who were candidates to receive anthracycline-based chemotherapy were included.
All participants underwent detailed cardiovascular characterization through cardiac magnetic resonance imaging, echocardiography, and serial measurement of cardiac biomarkers before, during, and after oncological treatment.
Mild alterations and the role of biomarkers
Almost half of the patients met criteria for cardiac dysfunction related to oncological treatment when the current definitions of European guidelines were strictly applied. However, this proportion decreased significantly when certain blood biomarkers were not taken into account.
Furthermore, although alterations were detected, most were mild, transient, and progressive, without translating into relevant cardiovascular events during follow-up months after treatment.
The team also found that a significant part of the elevations in biomarkers was already present before starting chemotherapy and tended to normalize over time, suggesting that it could reflect processes related to the oncological disease or systemic stress, rather than progressive cardiac damage.
In this way, the study supports the need to adapt the intensity of cardiac monitoring to the individual risk of each patient. "These findings suggest that a personalized approach according to risk could be more efficient than applying intensive monitoring protocols uniformly to all patients," highlighted the scientific director of the CNIC and leader of the work, Borja Ibáñez, cardiologist at the Hospital Universitario Fundación Jiménez Díaz and group leader at the CIBER of cardiovascular diseases (CIBERCV).
The authors emphasize that the early detection of cardiotoxicity remains a priority objective, but their results indicate that it is necessary to better adjust the balance between early diagnosis, real clinical benefit, and consumption of healthcare resources.
Although they have pointed out that the results should be interpreted with caution due to the relatively small size of the cohort and the duration of the follow-up, they have stated that they provide relevant information for future updates of cardiovascular monitoring strategies in oncological patients.
The cardiologist at the Hospital Universitario La Paz in Madrid, director of the Cardio-Oncology Section of the European Society of Cardiology and co-author of the study, Teresa López-Fernández, has highlighted the importance of conducting larger studies, with longer follow-ups, that allow determining which subclinical findings are truly prognostically relevant and which patients benefit most from intensive monitoring.
The prospective study "Matrix" is funded by the European Commission and, together with the CNIC, professionals from the Fundación Jiménez Díaz, the Cardiovascular Diseases area of the Biomedical Research Networking Center (CIBERCV), the Hospital Universitario La Paz, and international collaborators have worked on it.