CT Images in Follicular Lymphoma: Changes after Treatment Are Predictive of Cardiac Toxicity in Patients Treated with Anthracycline-Based or R-B Regimens

The aim of this study is to evaluate changes in epicardial adipose tissue (EAT) and cardiac extracellular volume (ECV) in patients with follicular lymphoma (FL) treated with R-CHOP-like regimens or R-bendamustine. We included 80 patients with FL between the ages of 60 and 80 and, using computed tomography (CT) performed at onset and at the end of treatment, we assessed changes in EAT by measuring tissue density at the level of the cardiac apex, anterior interventricular sulcus and posterior interventricular sulcus of the heart. EAT is known to be associated with metabolic syndrome, increased calcium in the coronary arteries and therefore increased risk of coronary artery disease. We also evaluated changes in ECV, which can be used as an early imaging marker of cardiac fibrosis and thus myocardial damage. The R-CHOP-like regimen was associated with lower EAT values (p < 0.001), indicative of a less active metabolism and more adipose tissue, and an increase in ECV (p < 0.001). Furthermore, in patients treated with anthracyclines and steroids (R-CHOP-like) there is a greater decrease in ejection fraction (EF p < 0.001) than in the R-B group. EAT and ECV may represent early biomarkers of cardiological damage, and this may be considered, to our knowledge, the first study investigating radiological and cardiological parameters in patients with FL

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Il consenso informato in aferesi:il punto di vista del nefrologo.

Since its first use apheresis has changed, developing in terms of different materials and techniques, and has been applied to treat several types of diseases. Thus, apheresis has become a complex therapeutical device that requires particular knowledge and expertise. 
Overall the use of this technique has been poorly managed in Italy, as well as in Europe, since physicians cannot refer to specific guidelines for its application. The purpose of a study group created in 1993 by the Italian Nephrology Society, is to develop such guidelines and protocols with a multidisciplinary approach. This allows different specializations to bring their knowledge together in a collaboration that will not only result in the realization of a common goal, but will also allow to clarify specific aspects of their own specialty. Informed consent is a fundamental act in medicine, as it legitimates every medical action. We suggest using a standard process to obtain the consent in any case requiring apheresis