Cardiovascular Complications Due to Treatment Regimens in Pediatric Lymphoma Patients: A Systematic Review Publisher



Alizadehas A ; Mahdavi M ; Jebelli S F H ; Aliabadi A Y ; Zonooz Y A ; Elahi M ; Salehi M M ; Hakimian H ; Hejri G M
Source: Iranian Journal of Pediatric Hematology and Oncology Published:2026

Abstract

Background: Lymphoma is among the most common malignancies in children, and improved survival has increased the importance of treatment-related late effects. Cardiovascular complications may result from the lymphoma itself or from chemotherapy and radiotherapy and can occur during treatment or years after exposure. This systematic review summarizes cardiovascular complications associated with pediatric lymphoma and its treatment. Materials and Methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. PubMed, EMBASE, and the Cochrane Library were searched from January 1, 1990, through July 20, 2024. Eligible studies included patients younger than 18 years with Hodgkin lymphoma or non-Hodgkin lymphoma and evaluated cardiovascular complications associated with chemotherapy and/or radiotherapy. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Because of substantial clinical and methodological heterogeneity, findings were synthesized qualitatively. Results: The search identified 930 records, of which 67 were considered potentially eligible after title and abstract screening. Following full-text assessment, 11 studies met the inclusion criteria. Reported cardiovascular outcomes included cardiomyopathy, ventricular dysfunction, arrhythmias, coronary artery disease, valvular abnormalities, pericardial disease, and other vascular complications. Anthracycline exposure was consistently associated with cardiotoxicity, while mediastinal radiotherapy was associated with important long-term coronary, valvular, and conduction abnormalities. Studies evaluating dexrazoxane suggested a cardioprotective effect without compromising antitumor efficacy. Conclusion: Cardiovascular complications are an important long-term concern in children and adolescents treated for lymphoma. The available evidence supports risk-adapted cardiovascular surveillance during treatment and long-term survivorship, with particular attention to cumulative anthracycline exposure and mediastinal radiotherapy. Larger prospective studies are needed to define standardized surveillance strategies and clarify the long-term cardiovascular effects of contemporary treatment regimens. © This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License.