Evaluation of cardiovascular autonomic functions compared with clinical response in patients with malignant lymphomas before and after chemotherapy

ABSTRACT

54 patients presented with malignant lymphoma [20 cases with Hodgkin's disease, 11 with low grade non-HodgKin's lymphoma and 23 with high grade non-Hodgkin's lymphoma] were studied. All had advanced disease [stage II B, III and IV], requiring combination chemotherapy which included the use of vinca alkaloids. Clinical assessment and standard cardiovascular autonomic function tests were carried out prior to and following completion of chemotherapy treatment and 8 weeks after whenever possible. At presentation forty patients 40/54 [74%] had abnormal cardiovascular autonomic function tests and there was no correlation with the presence or absence of mediastinal disease. Significant improvement in autonomic scores at the end of treatment were recorded in 26/40 [65%] patients despite the use of drugs with known neurocardiac toxicity, but others 14/40 [35%] showed residual abnormalities of cardiovascular autonomic functions despite clinical resolution of the disease. After 8 weeks from completion of chemotherapy treatment autonomic scores showed further improvement in four patients [complete remission was achieved]. It was suggested that subclinical autonomic dysfunction is common in patients with malignant lymphoma and probably it may represent a paraneoplastic syndrome rather than toxic effects of the drugs used, but its pathogenesis and prevalence of which deserve further study. This phenomenon may predispose the patients with lymphoma to develop other autonomic dysfunction in gastrointestinal and genitourinary tract and should be considered during the evaluation of neurotoxicity of chemotherapy regimens used