Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma

Mulrooney, Daniel A.; Nunnery, Sara; Armstrong, Gregory T.; Ness, Kirsten K.; Srivastava, Deokumar; Donovan, Fiona; Kurt, Beth A.; Metzger, Monika L.; Krasin, Matthew J.; Joshi, Vijaya M.; Durand, Jean Bernard; Robison, Leslie L.; Hudson, Melissa M.; Flamm, Scott D.

doi:10.1002/cncr.28925

Cited by 45 publications

(20 citation statements)

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“…In fact, using CT angiography screening in a pilot study of Hodgkin lymphoma survivors from the SJLIFE cohort, we found obstructive and non-obstructive coronary disease, with 67% of the lesions located in the proximal coronary circulation. (35)…”

Section: Discussionmentioning

confidence: 99%

Cardiac Outcomes in Adult Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy

Armstrong²,

et al. 2016

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Background Studies of cardiac disease among adult survivors of childhood cancer have generally relied upon self-reported or registry-based data. Objective Systematically assess cardiac outcomes among childhood cancer survivors Design Cross-sectional Setting St. Jude Children's Research Hospital Patients 1,853 adult survivors of childhood cancer, ≥18 years old, and ≥10 years from treatment with cardiotoxic therapy for childhood cancer. Measurements History/physical examination, fasting metabolic and lipid panels, echocardiogram, electrocardiogram (ECG), 6-minute walk test (6MWT) all collected at baseline evaluation. Results Half (52.3%) of the survivors were male, median age 8.0 years (range: 0-24) at cancer diagnosis, 31.0 years (18-60) at evaluation. Cardiomyopathy was present in 7.4% (newly identified at the time of evaluation in 4.7%), coronary artery disease (CAD) in 3.8% (newly identified in 2.2%), valvular regurgitation/stenosis in 28.0% (newly identified in 24.8%), and conduction/rhythm abnormalities in 4.6% (newly identified in 1.4%). Nearly all (99.7%) were asymptomatic. The prevalences of cardiac conditions increased with age at evaluation, ranging from 3-24% among those 30-39 years to 10-37% among those ≥40 years. On multivariable analysis, anthracycline exposure ≥250 mg/m2 increased the odds of cardiomyopathy (odds ratio [OR] 2.7, 95% CI 1.1-6.9) compared to anthracycline unexposed survivors. Radiation to the heart increased the odds of cardiomyopathy (OR 1.9 95% CI 1.1-3.7) compared to radiation unexposed survivors. Radiation >1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings. Limitations 61% participation rate of survivors exposed to cardiotoxic therapies, which were limited to anthracyclines and cardiac-directed radiation. A comparison group and longitudinal assessments are not available. Conclusions Cardiovascular screening identified considerable subclinical disease among adult survivors of childhood cancer. Funding Cancer Center Support Grant (CA21765), U01 CA195547 1, American Lebanese Syrian Associated Charities

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Section: Discussionmentioning

confidence: 99%

Cardiac Outcomes in Adult Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy

Armstrong²,

et al. 2016

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“…72 Coronary artery disease, detected with computed tomography angiography, was prevalent among 39% of 31 survivors of HL (median age, 40 years [range, 26-55 years]) exposed to chest radiation during childhood. 73 Finally, Sulicka et al reported a chronic proinflammatory state among 27 survivors of childhood ALL (age range, 18-27 years) when compared with normal controls. 74 Survivors of ALL exhibited elevated levels of pentraxin-3, soluble vascular cell adhesion molecule-1, osteoprotegerin, tumor necrosis factor-related apoptosis-inducing ligand, and counts of intermediate monocytes.…”

Section: Frailty In Childhood Cancer Survivors/ness Et Almentioning

confidence: 99%

“…Survivors of Wilms tumor, leukemia, CNS tumors, germ cell tumors, malignant bone tumors, and HL were found to be at greatest risk . Coronary artery disease, detected with computed tomography angiography, was prevalent among 39% of 31 survivors of HL (median age, 40 years [range, 26‐55 years]) exposed to chest radiation during childhood . Finally, Sulicka et al reported a chronic proinflammatory state among 27 survivors of childhood ALL (age range, 18‐27 years) when compared with normal controls .…”

Section: Introductionmentioning

confidence: 99%

Frailty in childhood cancer survivors

Ness

Armstrong

Kundu

et al. 2014

Cancer

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Young adult childhood cancer survivors are at increased risk for frailty, a physiologic phenotype typically found among older adults. This phenotype is associated with new onset chronic health conditions and mortality among both older adults and among childhood cancer survivors. Mounting evidence suggests that poor fitness, muscular weakness and cognitive decline are common among adults treated for childhood malignancies, and that risk factors for these outcomes are not limited to those treated with cranial radiation. Although the pathobiology of this phenotype is not known, early cellular senescence, sterile inflammation and mitochondrial dysfunction in response to initial cancer or treatment related insults are hypothesized to play a role. Interventions to prevent or remediate frailty among childhood cancer survivors have not been tested. Pharmaceutical, nutriceutical and lifestyle interventions show some promise.

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“…In a study of screening echocardiography for more than 1800 adult survivors of childhood cancer treated with anthracycline chemotherapy (+/-radiation to the left chest), asymptomatic CAD was found in 69 patients (3.8%) and newly identified (not previously diagnosed) in 40 patients (2.2%), and valvular regurgitation or stenosis was found in 488 patients (28%), newly identified in 414 patients (23.8%) [6]. In pilot studies, screening CT coronary angiography has identified clinically significant CAD requiring percutaneous or surgical revascularization in asymptomatic survivors of Hodgkin lymphoma exposed to mediastinal radiation therapy; larger studies are needed to determine the utility of this approach for identifying CAD in cancer survivors at high risk [7][8][9][10].…”

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confidence: 99%