Mortality in Patients With Hodgkin Lymphoma and Heart Failure: A Swedish Population-Based Study

While individuals treated for classical Hodgkin lymphoma (cHL) have an increased risk of heart failure (HF), the effect on survival is less clear.

The purpose of this study was to compare all-cause mortality following HF diagnosis between patients with prior cHL and comparators, with cardiovascular (CV)-specific mortality as an explorative outcome.

Patients with cHL and subsequent HF were matched 1:2 with comparators with HF on sex, birth year, year of HF, and contact type (inpatient/outpatient). Follow-up began at HF and ended upon death or censoring (emigration; December 31, 2023; or maximum 5 years). HRs with 95% CIs were estimated using flexible parametric survival models adjusted for matching variables.

Between 2000 and 2022, 257 patients with cHL and 514 comparators were included. The median age was 73 years, and males predominated (64%). Over a median follow-up of 2.5 years for cHL and 3.3 years for comparators, respectively, 130 (51%) and 192 (37%) died. Lymphoma-related death dominated in the cHL group (40%), while CV death dominated among comparators (42%). All-cause mortality was higher for patients with HF and prior cHL than HF comparators (HR: 1.81; 95% CI: 1.44-2.26). CV-specific mortality did not differ overall (HR: 1.17; 95% CI: 0.78-1.75) except for patients with HF ≥10 years after cHL (HR: 3.13; 95% CI: 1.71-5.73).

cHL was associated with higher all-cause mortality following HF diagnosis. CV-specific mortality was significantly higher for patients with HF ≥10 years after cHL, possibly highlighting the impact of late treatment toxicity, although careful interpretation is warranted given the strong competing risk of lymphoma-related deaths.