The more patients you treat, the more you cure: managing cardiotoxicity in the treatment of aggressive non-Hodgkin lymphoma

Athracycline-based regimens remain the gold standard for the treatment of lymphomas, even if their use can be limited by associated cardiac toxicity, especially in elderly patients. Although most patients with aggressive non-Hodgkin lymphoma (NHL) are elderly, they may envisage long-term life expectancy. Thus, there is a need for therapeutic strategies that can overcome the impact of anthracycline cardiotoxicity. A better understanding of its pathogenetic mechanisms, the identification of risk factors of cardiac dysfunction, and appropriate therapy should prove useful in this setting. A comparable efficacy and reduced cardiotoxicity even in frail and elderly patients have been shown with the use of non-pegylated liposomal doxorubicin, when substituted for conventional doxorubicin in standard chemotherapy regimens for NHL. In the coming years, the goal will be to apply these advancements to the treatment of patients with NHL, to ensure adequate therapy in patients currently denied conventional intensive chemotherapy because of age or comorbidities.