# Evaluation of Cardiotoxicity in Lymphoproliferative Patients Treated With Anthracycline and Bruton's Tyrosine Kinase Inhibitor-Based Regimens

## TL;DR

This study compares the cardiotoxic effects of anthracyclines and BTK inhibitors in lymphoproliferative patients, finding that anthracyclines cause quicker and more severe heart issues.

## Contribution

The study provides new insights into the timing and severity of cardiotoxicity between anthracyclines and BTK inhibitors in lymphoproliferative patients.

## Key findings

- Anthracyclines caused cardiotoxic effects within 0-91 days post-treatment.
- BTK inhibitors caused cardiotoxic effects 245-1539 days post-treatment.
- Anthracyclines showed a more pronounced cardiotoxic burden compared to BTK inhibitors.

## Abstract

Background: The treatment of lymphoproliferative disorders has often included a range of cardiotoxic chemotherapy-focused regimens, in particular Bruton’s tyrosine kinase inhibitors (BTKi) and anthracyclines. Despite these agents being commonly used in clinical practice, the specific process of cardiotoxicity and the prevention of the subsequent cardiac-based pathologies, including atrial fibrillation and hypertension, are increasing points of research. Many hematology-oncology tertiary centers incorporate these agents into regular treatment regimens for patients. A retrospective study from a large patient cohort was pivotal in highlighting the specific cardiovascular risks involved with the applications of these agents. Adding to this, the increased scope of evidence shows an estimated 2-4% of all patients treated with anthracyclines developing left ventricular dysfunction after nine years, with six to eight people per 1000 persons treated with BTKis developing ventricular arrhythmias and/or sudden cardiac death.

Materials and methods: The study population comprised 389 patients included in the patient study pool from January 2018 to June 2023. The medical histories of all patients were reviewed to determine the incidence of specific cardiac-related pathologies such as atrial fibrillation, ventricular arrhythmias, cardiac arrest/sudden death, heart failure, and hypertension, both pre- and post-chemotherapy administration. The patients were divided into an anthracycline and a BTKi cohort, of which 2% of the anthracycline cohort presented with either atrial fibrillation, ventricular tachycardia, or heart failure, while 6% of the BTKi cohort presented with either atrial fibrillation, hypertension, or heart failure.

Results: Cardiotoxic effects were noted in a shorter timespan post-anthracycline administration (0-91 days) as compared to post-BTKi administration (245-1539 days).

Conclusions: Our study identifies a significant cardiotoxic burden following chemotherapy initiation, which is most pronounced with the application of anthracyclines as compared to BTKis. This evidence may benefit patients with lymphoproliferative disorders through prospective cardiovascular assessment and monitoring before, during, and after treatment.