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

Patients 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 under-characterized. We conducted a nationwide cohort study of 8,453 Swedish patients diagnosed with LBCL (median age 70 years) between 2007-2022 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 two-fold increased rate, driven mainly by non-ischemic HF (hazard ratio [HR]non-ischemic 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 non-ischemic 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, n=84) of whom none developed HF. Patients selected for intensive treatment (e.g., R-CHOEP/R-DA-EPOCH) were not at higher risk of HF compared 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, LBCL patients had consistently higher all-cause (but not cardiovascular) mortality than comparators. Our findings indicate that LBCL patients face a sustained long-term risk of non-ischemic HF, highlighting the importance of survivorship care and vigilant HF symptom screening.