Clinical and subclinical cardiac late effects in pediatric Hodgkin's lymphoma survivors
Carlo Materazzo1, Maura Massimino2, Elisabetta Schiavello2
1Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Insights
Long-term cardiac effects are common in childhood Hodgkin
Area of Science:
- Cardiology
- Oncology
- Pediatric Survivorship
Background:
- Pediatric Hodgkin's lymphoma (HL) survivors face significant mortality and morbidity from cardiac late effects.
- The ABVD regimen (doxorubicin, bleomycin, vinblastine, dacarbazine) and radiotherapy (RT) were standard treatments in the 1980s.
- Assessing long-term cardiac sequelae in this cohort is crucial for understanding late-onset complications.
Purpose of the Study:
- To evaluate clinical and subclinical cardiac sequelae in childhood Hodgkin's lymphoma survivors (HLS).
- To assess cardiac health in HLS treated with the ABVD regimen and limited-field radiotherapy during the 1980s.
- To identify cardiac abnormalities at least 20 years post-treatment.
Main Methods:
- Retrospective examination of HLS treated between 1979 and 1989.
- Cardiac assessment in asymptomatic individuals included physical examination, ECG, and rest/exercise echocardiography.
- Focus on detecting subtle cardiac abnormalities at least 20 years after therapy completion.
Main Results:
- No significant physical or ECG abnormalities were found in 53 asymptomatic HLS 21 years post-diagnosis.
- Valvular abnormalities were present in 41% of patients (mitral regurgitation 28%, aortic regurgitation 9%).
- Mild pericardial alterations were noted in 2 individuals; no significant myocardial dysfunction was identified.
Conclusions:
- Long-term cardiac effects, particularly coronary artery disease and valvular abnormalities, are common in HLS treated with ABVD and RT.
- The study identified frequent valvular issues but no overt congestive heart failure in this cohort.
- Findings highlight the need for ongoing cardiac surveillance in Hodgkin's lymphoma survivors.
Purpose:
Cardiac late effects are responsible for a significant burden of mortality and morbidity among pediatric Hodgkin's lymphoma (HL) survivors (HLS). The aim of our study was to assess clinical and subclinical cardiac sequelae in a cohort of childhood HLS treated in the 1980s with doxorubicin, bleomycin, vinblastine, and dacarbazine (the ABVD regimen) and limited-field radiotherapy (RT).
Methods:
We retrospectively examined a series of HLS treated from 1979 to 1989. We searched for subtle cardiac abnormalities in a subgroup of asymptomatic individuals, who underwent rest and exercise echocardiography at least 20 years after completing their therapies. Their cardiac assessment included physical examination, electrocardiogram (ECG), and resting and postexercise echocardiograms.
Results:
On thorough cardiac assessment a mean of 21 years after their diagnosis, none of the 53 unselected asymptomatic HLS showed physical signs or significant ECG abnormalities during or after the stress echo test. Twenty-two (41%) of the 53 patients revealed valvular abnormalities, with mitral regurgitation in 28%, aortic regurgitation in 9%, and both in 4%. No significant myocardial dysfunction as a result of previous combined doxorubicin treatment and chest RT was identified. Only 2 individuals had mild pericardial alterations.
Conclusions:
The present study shows that long-term cardiac effects are common in HLS treated with the ABVD regimen and RT. The most frequent complications observed in this sample were essentially coronary artery disease and valvular abnormalities. None of the survivors in this sample showed overt congestive heart failure, a finding in contrast with larger studies.
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