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Long-term cause-specific mortality of patients treated for Hodgkin's disease

Berthe M P Aleman1, Alexandra W van den Belt-Dusebout, Willem J Klokman

  • 1Department of Epidemiology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|July 30, 2003
PubMed

Insights

Young Hodgkin's disease patients face significantly increased long-term mortality from causes other than their initial cancer. This elevated risk, particularly for solid tumors and cardiovascular disease, persists for decades, especially in those treated before age 21.

Area of Science:

  • Oncology
  • Epidemiology
  • Public Health

Background:

  • Hodgkin's disease (HD) survivors often face long-term health challenges.
  • Assessing cause-specific mortality is crucial for understanding the late effects of HD treatment.

Purpose of the Study:

  • To evaluate the long-term, cause-specific mortality risks in young Hodgkin's disease patients.
  • To compare mortality rates of HD survivors to the general population.

Main Methods:

  • A cohort of 1,261 patients treated for HD before age 41 (1965-1987) was followed until October 2000.
  • Cause-specific mortality was determined for 95% of deaths.
  • Relative risk (RR) and absolute excess risk (AER) were calculated against general population rates.

Main Results:

  • After a median of 17.8 years, 534 patients died, 55% from HD.
  • The RR of non-HD death was 6.8, remaining 5.1 even after 30 years.
  • Elevated RRs for solid tumors (6.6) and cardiovascular disease (6.3) were observed, particularly in those treated before age 21 (14.8 and 13.6, respectively).
  • Salvage chemotherapy was associated with a higher RR of solid tumor death.

Conclusions:

  • While HD itself was the primary cause of early death, its mortality became negligible after 20 years.
  • The risks of death from second primary cancers and cardiovascular disease continued to rise over time.
  • HD patients, especially those treated before age 21, face a persistently elevated risk of non-HD mortality, though this risk may decrease with age.
Abstract

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