Cardiac morbidity following modern treatment for Hodgkin lymphoma: Supra-additive cardiotoxicity of doxorubicin and radiation therapy

Abstract

Age- and sex-specific estimates of the rate of cardiac morbidity among Hodgkin lymphoma (HL) patients treated with doxorubicin-based chemotherapy and radiation therapy (RT) are scarce. We evaluated the risk of hospital admission for cardiac disease in 615 HL patients, adjusting for age, sex, treatment, cardiac risk factors and competing causes of death. Compared with the general population, the risk of cardiac morbidity was highest among patients treated with both doxorubicin and mediastinal RT (HR = 2.77, p < 0.0001). Mediastinal RT without chemotherapy also significantly increased the risk (HR = 1.82, p = 0.038). For females and males treated with doxorubicin plus mediastinal RT at age 40, the estimated 15-year incidence rate of cardiac hospitalisation were 7.3% and 16.5%, respectively, rates 5-15% higher than expected. These results suggest that the risk of clinically important cardiac toxicity following HL treatment that includes both doxorubicin and mediastinal RT may be greater than that reported in prior studies of patients treated with RT alone.

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

“…Several studies of cause‐specific mortality in survivors of Hodgkin lymphoma diagnosed in childhood or early adult life have been carried out,19, 20, 21 and the risk of hospitalisation among survivors of all types of cancer diagnosed in adolescence and young adulthood has been studied in other populations 22, 23, 24, 25. Other studies specifically of survivors of Hodgkin lymphoma diagnosed in young adulthood have usually reported on specific risks of second cancers11, 26, 27, 28, 29, 30, 31, 32, 33 or cardiovascular diseases 12, 34, 35, 36. The results of our study are in agreement with their findings.…”

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

“…Several studies suggest that anthracycline-containing chemotherapy further increases the radiotherapy-related risk of VHD and HF by two-to threefold compared with radiotherapy alone. 11,51,53 This effect was additive in a recent report 11 and more than additive in another study. Three recent case-control studies addressed the shape of the radiation dose-response curve for CHD and VHD after HL treatment.…”

Unstable angina in a young woman with Hodgkin&#8217;s lymphoma

“…Myrehaug et al [9] reported that treatment with both anthracycline and radiation is associated with a significantly increased risk of cardiac events (RR 2.8). The risk was lower for patients given only mediastinal irradiation (RR 1.9).…”