Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

Abstract

Long-term survivors of Hodgkin lymphoma (HL) are at an increased risk for a range of late complications, with subsequent malignant neoplasm and cardiovascular disease representing the 2 leading causes of death in these patients. Raising awareness, close follow-up, and adoption of selected earlydetection and risk-reduction strategies may help to reduce the adverse impact of these late effects on patients. This chapter reviews known long-term complications of HL therapy, risk factors, and the timing of their occurrence. Where available, data on the efficacy of screening for selected late effects of HL are presented. Current evidence-based and consensus-based recommendations on follow-up of longterm HL survivors are also reviewed. As HL therapy evolves over time, late effects and implications on follow-up of patients treated in the contemporary era should be considered and opportunities for future research should be explored. (Blood. 2014; 124(23):3373-3379)

Sociodemographic disparities in the occurrence of medical conditions among adolescent and young adult Hodgkin lymphoma survivors

“…Long-term AYA HL survivors in Denmark were found to be at increased risk of hospitalization for the medical conditions considered in this study, including second cancers, circulatory system, respiratory system and endocrine diseases [15,26]. Prior studies have also noted increased risks among HL cancer survivors for second cancers, cardiovascular disease and hypothyroidism [7–12,14,18], conditions likely resulting from mediastinal radiation and anthracycline-based chemotherapy [1,8,18,9]. Furthermore, consistent with studies showing increased mortality from cardiovascular disease and subsequent cancers in long-term HL survivors [12,9,14], this study observed higher mortality among AYAs who experienced medical conditions.…”

“…We considered hypothyroidism (ICD-9-CM 244) separately from endocrine and related diseases based on prior studies [18,9]. Second cancers were identified by the CCR.…”

Risk of Second Cancer in Hodgkin Lymphoma Survivors and Influence of Family History

“…Furthermore, our findings with respect to lung cancer emphasize the importance of instigating programs to reduce smoking in patients with HL. Finally, as well as offering breast cancer screening to women who have received supradiaphragmatic radiotherapy, 43,44 obtaining family history information has a place in informing the long-term follow-up screening of all patients with HL.…”

Should Response-Adapted Therapy Now Be the Standard of Care for Advanced Hodgkin’s Lymphoma?

“…The use of both radiotherapy and alkalating chemotherapy increases the risk of lung cancer in HL survivors. This is directly related to higher radiation dosage, where there is a 7-fold to 9-fold increase in patients receiving doses >30 Gy compared with <5 Gy [5]. The overall survival of these patients is significantly lower compared to other patients with lung cancer, possibly due to prior radiation exposure limiting treatment options or a more aggressive form of the disease induced by radiation.…”