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However, the relative contribution of anthracyclines to the development of congestive heart failure (<jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content>), when included in a poly\u2010chemotherapy regimen, is unclear. We examined cardiotoxicity in adult patients with diffuse large B\u2010cell lymphoma and follicular lymphoma undergoing first\u2010line immunochemotherapy from 2000\u20132012. In total, 2440 patients without previous heart disease were identified from the Danish Lymphoma Registry, of which 1994 (81\u00b77%) were treated with anthracycline\u2010containing chemotherapy [R\u2010<jats:styled-content style=\"fixed-case\">CHOP<\/jats:styled-content> (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) or R\u2010<jats:styled-content style=\"fixed-case\">CHOEP<\/jats:styled-content> (R\u2010<jats:styled-content style=\"fixed-case\">CHOP<\/jats:styled-content> + etoposide)] and 446 (18\u00b73%) were treated without anthracyclines (reference group). Compared to the reference group, the adjusted hazard ratio of <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> after 3\u20135 cycles of R\u2010<jats:styled-content style=\"fixed-case\">CHOP<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">CHOEP<\/jats:styled-content> was 5\u00b70 [95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 1\u00b74; 18\u00b75], 6 cycles 6\u00b78 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2\u00b70; 23\u00b73) and &gt;6 cycles 13\u00b74 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 4\u00b70; 45\u00b70). The cumulative 5\u2010year risk of <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> with all\u2010cause mortality as competing risk was 4\u00b76% after 3\u20135 cycles of R\u2010<jats:styled-content style=\"fixed-case\">CHOP<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">CHOEP<\/jats:styled-content>, 4\u00b75% after 6 and 7\u00b79% after more than 6 cycles. Cumulative 5\u2010year risk for patients treated without anthracyclines was 0\u00b78%. Using anthracyclines in first\u2010line lymphoma treatment increases risk of <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> in patients without previous history of heart disease. In particular, treatment with &gt;6 cycles of R\u2010<jats:styled-content style=\"fixed-case\">CHOP<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">CHOEP<\/jats:styled-content> is associated with a significant increase in <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> rate.<\/jats:p>","DOI":"10.1111\/bjh.15603","type":"journal-article","created":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T13:30:20Z","timestamp":1541683820000},"page":"717-726","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Cumulative anthracycline exposure and risk of cardiotoxicity; a Danish nationwide cohort study of 2440 lymphoma patients treated with or without anthracyclines"],"prefix":"10.1111","volume":"183","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8848-4879","authenticated-orcid":false,"given":"Joachim","family":"Baech","sequence":"first","affiliation":[{"name":"Department of Haematology Aalborg University Hospital Aalborg Denmark"},{"name":"Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steen M.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E.","family":"Lund","sequence":"additional","affiliation":[{"name":"Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Soegaard","sequence":"additional","affiliation":[{"name":"Department of Cardiology Aalborg University Hospital Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter de Nully","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Haematology Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Haaber","sequence":"additional","affiliation":[{"name":"Department of Haematology Odense University Hospital Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judit","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Department of Haematology Aarhus University Hospital Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f8rn","family":"Starklint","sequence":"additional","affiliation":[{"name":"Department of Haematology Holstebro Hospital Holstebro Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e4r","family":"Josefsson","sequence":"additional","affiliation":[{"name":"Department of Haematology Herlev Hospital Copenhagen University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian B.","family":"Poulsen","sequence":"additional","affiliation":[{"name":"Department of Haematology Zealand University Hospital Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja B.","family":"Juul","sequence":"additional","affiliation":[{"name":"Department of Haematology Sygehus Lillebaelt Vejle Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Torp\u2010Pedersen","sequence":"additional","affiliation":[{"name":"Department of Health Science and Technology Aalborg University Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarec C.","family":"El\u2010Galaly","sequence":"additional","affiliation":[{"name":"Department of Haematology Aalborg University Hospital Aalborg Denmark"},{"name":"Department of Clinical Medicine Aalborg University Hospital Aalborg Denmark"},{"name":"Clinical Cancer Research Centre Aalborg University Hospital Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157999"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013777"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011795"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"3060","DOI":"10.1016\/S0021-9258(17)35746-0","article-title":"Redox cycling of anthracyclines by cardiac mitochondria. 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