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Published on: May 16, 2020

Late cardiotoxicity after treatment for Hodgkin lymphoma

Berthe M P Aleman1, Alexandra W van den Belt-Dusebout, Marie L De Bruin

  • 1Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Blood
|November 23, 2006
PubMed

Insights

Survivors of Hodgkin lymphoma (HL) face significantly increased risks of cardiovascular diseases (CVDs), including myocardial infarction and heart failure, even decades after treatment. Mediastinal radiotherapy and anthracyclines further elevate these risks, particularly for heart failure and valvular disorders.

Area of Science:

  • Cardiology
  • Oncology
  • Epidemiology

Background:

  • Hodgkin lymphoma (HL) survivors treated at a young age are at risk for long-term health issues.
  • Cardiovascular disease (CVD) is a significant concern in cancer survivors.
  • Understanding treatment-related CVD risks is crucial for long-term patient management.

Purpose of the Study:

  • To assess the long-term incidence of cardiovascular disease (CVD) in young Hodgkin lymphoma (HL) survivors.
  • To quantify the impact of mediastinal radiotherapy and anthracyclines on CVD risk.
  • To analyze treatment effects on specific CVD outcomes like myocardial infarction (MI) and congestive heart failure (CHF).

Main Methods:

  • Analysis of cardiovascular disease incidence in 1474 Hodgkin lymphoma survivors treated before age 41.
  • Utilized multivariable Cox regression and competing risk analyses to evaluate treatment effects.
  • Follow-up duration averaged 18.7 years, with some extending to 25 years.

Main Results:

  • Significantly elevated risks for myocardial infarction (MI) (SIR=3.6) and congestive heart failure (CHF) (SIR=4.9) observed.
  • Mediastinal radiotherapy increased risks of MI, angina, CHF, and valvular disorders (2- to 7-fold).
  • Anthracyclines added to risks of CHF and valvular disorders following mediastinal radiotherapy (HRs 2.81 and 2.10).

Conclusions:

  • Hodgkin lymphoma survivors experience a 3- to 5-fold increased risk of various CVDs long after treatment.
  • Risks persist for at least 25 years, with younger patients facing higher relative risks.
  • Combined mediastinal radiotherapy and anthracyclines result in a 7.9% cumulative incidence of CHF by 25 years.

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