Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy
Background: Low hemoglobin values are associated with cardiotoxicity in patients with melanoma and other cancer entities receiving immune checkpoint inhibitor (ICI) therapy. However, in cancer patients under chemotherapy, enhanced incidence of cardiotoxicity events are also reported with increasing...
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Elsevier
2025-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S235290672500096X |
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| author | Elias Haj-Yehia Raluca I. Mincu Phillip Schulte Sebastian Korste Samuel Dautzenberg Lars Michel Amir A. Mahabadi Tienush Rassaf Matthias Totzeck |
| author_facet | Elias Haj-Yehia Raluca I. Mincu Phillip Schulte Sebastian Korste Samuel Dautzenberg Lars Michel Amir A. Mahabadi Tienush Rassaf Matthias Totzeck |
| author_sort | Elias Haj-Yehia |
| collection | DOAJ |
| description | Background: Low hemoglobin values are associated with cardiotoxicity in patients with melanoma and other cancer entities receiving immune checkpoint inhibitor (ICI) therapy. However, in cancer patients under chemotherapy, enhanced incidence of cardiotoxicity events are also reported with increasing hemoglobin values. So far, the association between hemoglobin values within the normal limits and the incidence of cardiotoxicity in melanoma patients treated with ICI therapy has not been examined. Methods: We analyzed 114 melanoma patients receiving ICI therapy (61 ± 13 years; 38 % female) from the prospective Essen Cardio-Oncology Registry (EcoR). Patients with cancer-related anemia (hemoglobin < 11 g/dL) were excluded from the analysis. Baseline hemoglobin levels were assessed at patient enrollment before initiation of ICI therapy. Endpoint was the whole spectrum of cancer therapy-related cardiovascular toxicity (CTR-CVT) according to the European guidelines on cardio-oncology with a median follow-up of 464 days. Results: Hemoglobin values and overall CTR-CVT were positively associated with hazard ratio (HR) rising in a J-shaped curve depending on increasing hemoglobin values. Subgroup analysis revealed only a significant association of hemoglobin and cancer therapy-related cardiac dysfunction (CTRCD) (HR: 1.417; 95 % confidence interval (CI): 1.101 – 1.825; p = 0.007). This association also remained significant after adjustment for further confounders. Conclusions: Hemoglobin values within the normal limits are associated with cardiovascular toxicity in terms of CTRCD in this cohort of melanoma patients receiving ICI treatment. Future studies are needed to investigate underlying mechanisms and validate the clinical utility of hemoglobin as a potential additional biomarker for risk stratification in cancer patients. |
| format | Article |
| id | doaj-art-b3f70021278e4d6dbda34bd8e46b0f35 |
| institution | DOAJ |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-b3f70021278e4d6dbda34bd8e46b0f352025-08-20T02:56:29ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-08-015910169310.1016/j.ijcha.2025.101693Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapyElias Haj-Yehia0Raluca I. Mincu1Phillip Schulte2Sebastian Korste3Samuel Dautzenberg4Lars Michel5Amir A. Mahabadi6Tienush Rassaf7Matthias Totzeck8Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyCorresponding author at: Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, GermanyBackground: Low hemoglobin values are associated with cardiotoxicity in patients with melanoma and other cancer entities receiving immune checkpoint inhibitor (ICI) therapy. However, in cancer patients under chemotherapy, enhanced incidence of cardiotoxicity events are also reported with increasing hemoglobin values. So far, the association between hemoglobin values within the normal limits and the incidence of cardiotoxicity in melanoma patients treated with ICI therapy has not been examined. Methods: We analyzed 114 melanoma patients receiving ICI therapy (61 ± 13 years; 38 % female) from the prospective Essen Cardio-Oncology Registry (EcoR). Patients with cancer-related anemia (hemoglobin < 11 g/dL) were excluded from the analysis. Baseline hemoglobin levels were assessed at patient enrollment before initiation of ICI therapy. Endpoint was the whole spectrum of cancer therapy-related cardiovascular toxicity (CTR-CVT) according to the European guidelines on cardio-oncology with a median follow-up of 464 days. Results: Hemoglobin values and overall CTR-CVT were positively associated with hazard ratio (HR) rising in a J-shaped curve depending on increasing hemoglobin values. Subgroup analysis revealed only a significant association of hemoglobin and cancer therapy-related cardiac dysfunction (CTRCD) (HR: 1.417; 95 % confidence interval (CI): 1.101 – 1.825; p = 0.007). This association also remained significant after adjustment for further confounders. Conclusions: Hemoglobin values within the normal limits are associated with cardiovascular toxicity in terms of CTRCD in this cohort of melanoma patients receiving ICI treatment. Future studies are needed to investigate underlying mechanisms and validate the clinical utility of hemoglobin as a potential additional biomarker for risk stratification in cancer patients.http://www.sciencedirect.com/science/article/pii/S235290672500096XImmune checkpoint inhibitorCancer therapy-related cardiovascular toxicityCancer therapy-related cardiac dysfunctionHemoglobinMelanoma |
| spellingShingle | Elias Haj-Yehia Raluca I. Mincu Phillip Schulte Sebastian Korste Samuel Dautzenberg Lars Michel Amir A. Mahabadi Tienush Rassaf Matthias Totzeck Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy International Journal of Cardiology: Heart & Vasculature Immune checkpoint inhibitor Cancer therapy-related cardiovascular toxicity Cancer therapy-related cardiac dysfunction Hemoglobin Melanoma |
| title | Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy |
| title_full | Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy |
| title_fullStr | Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy |
| title_full_unstemmed | Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy |
| title_short | Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy |
| title_sort | hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy |
| topic | Immune checkpoint inhibitor Cancer therapy-related cardiovascular toxicity Cancer therapy-related cardiac dysfunction Hemoglobin Melanoma |
| url | http://www.sciencedirect.com/science/article/pii/S235290672500096X |
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