Myocardial infarction in diffuse large B-cell lymphoma patients – a population-based matched cohort study

S. Ekberg, S. Harrysson, T. Jernberg, K. Szummer, P. O. Andersson, M. Jerkeman, K. E. Smedby, S. Eloranta

Research output: Contribution to journalArticlepeer-review


Background: The outcome for diffuse large B-cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R-CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. Method: We identified 3548 curatively treated DLBCL patients in Sweden diagnosed between 2007 and 2014, and 35474 matched lymphoma-free general population comparators. The incidence, characteristics and outcome of acute myocardial infarctions (AMIs) were assessed using population-based registers up to 11 years after diagnosis. The rate of AMI was estimated using flexible parametric models. Results: Overall, a 33% excess rate of AMI was observed among DLBCL patients compared with the general population (HR: 1.33, 95% CI: 1.14–1.55). The excess rate was highest during the first year after diagnosis and diminished after 2 years. High age, male sex and comorbidity were the strongest risk factors for AMI. Older patients (>70 years) with mild comorbidities (i.e. hypertension or diabetes) had a 61% higher AMI rate than comparators (HR: 1.61, 95% CI: 1.10–2.35), whereas the corresponding excess rate was 28% for patients with severe comorbidities (HR: 1.28, 95% CI: 1.01–1.64). Among younger patients (≤70), a short-term excess rate of AMI was limited to those with severe comorbidities. There was no difference in AMI characteristics, pharmacological treatment or 30-day survival among patients and comparators. Conclusion: DLBCL patients have an increased risk of AMI, especially during the first 2 years, which calls for improved cardiac monitoring guided by age and comorbidities. Importantly, DLBCL was not associated with differential AMI management or survival.

Original languageEnglish
Pages (from-to)1048-1060
JournalJournal of Internal Medicine
Issue number5
Early online date2021
Publication statusPublished - 2021

Subject classification (UKÄ)

  • Cancer and Oncology

Free keywords

  • acute myocardial infarction
  • cardiology
  • epidemiology
  • lymphoma


Dive into the research topics of 'Myocardial infarction in diffuse large B-cell lymphoma patients – a population-based matched cohort study'. Together they form a unique fingerprint.

Cite this