Incidence, timing, and prognosis of heart failure after treatment for large B-cell lymphoma in Sweden during 2007-2022.

abstractPatients with large B-cell lymphoma (LBCL) are at increased risk of heart failure (HF) potentially due to anthracycline-based chemotherapy. However, associations with LBCL treatment intensity, HF subtype, and outcome remain undercharacterized. We conducted a nationwide cohort study of 8453 Swedish patients diagnosed with LBCL (median age 70 years) between 2007 and 2022 and 71 506 matched population comparators without a history of HF. The 5-year cumulative incidence of new-onset HF among patients was 8.1% overall, corresponding to a twofold increased rate, driven mainly by nonischemic HF (hazard ratio [HR]nonischemic, 2.33; 95% confidence interval [CI], 2.16-2.50) and less by ischemic HF (HRischemic, 1.30; 95% CI, 1.04-1.62). An increased rate of new-onset nonischemic HF remained after 2 years of follow-up (HR, 1.78; 95% CI, 1.60-1.94). Few patients had reduced intensity treatment (4 R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone], n = 84) of whom none developed HF. Patients selected for intensive treatment (eg, R-CHOEP with etoposide or dose-adjustment [R-DA-EPOCH]) were not at higher risk of HF compared with those treated with standard R-CHOP (HR, 0.73; 95% CI, 0.58-0.92), although unmeasured differences in baseline fitness or frailty may have influenced treatment selection. After HF onset, patients with LBCL had consistently higher all-cause (but not cardiovascular) mortality than comparators. Our findings indicate that patients with LBCL face a sustained long-term risk of nonischemic HF, highlighting the importance of survivorship care and vigilant HF symptom screening.