Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

Abstract

Previous studies have shown increased cardiovascular mortality as late side effects in Hodgkin lymphoma (HL) patients. This study identifies stratifying risk factors for surveillance and defines concepts for a clinical feasible and noninvasive prospective protocol for intervention of cardiovascular side effects. HL patients diagnosed between 1965 and 1995 (n 5 6.946) and their first-degree relatives (FDR) were identified through the Swedish Cancer Registry and the Swedish Multigeneration Registry. For the HL and FDR cohort, in-patient care for cardiovascular disease (CVD) was registered through the Hospital Discharge Registry, Sweden. Standard incidence ratios of developing CVD for the HL cohort were calculated. A markedly increased risk for in-patient care of CVD was observed in HL patients with HL diagnosed at age 40 years or younger and with more than 10 years follow-up. In the HL survivors, a family history of congestive heart failure (CHF) and coronary artery disease (CAD) increased the risk for these diseases. The Swedish Hodgkin Intervention and Prevention study started in 2007. In the pilot feasibility study for prospective intervention (47 patients), about 25% of the cases had side effects and laboratory abnormalities. These patients were referred to a cardiologist or general practitioner. In the prospective cohort, a positive family history for CHF or CAD could be a stratifying risk factor when setting up a surveillance model. The prospective on-going study presents an intervention model that screens and treats for comorbidity factors. This article also presents an overview of the study concept.

ACR Appropriateness Criteria Follow-up of Hodgkin Lymphoma

“…Andersson et al [50] performed a retrospective review of Hodgkin lymphoma patients and their first-degree relatives through the Swedish Cancer Registry to identify stratifying risk factors for surveillance of cardiovascular side effects. The authors found that the risk of cardiovascular disease increased with young age at diagnosis, >10 years of followup, and a positive family history of congestive hear failure and coronary artery disease.…”

Cardiac Mortality in Children and Adolescents with Hodgkin's Lymphoma: A Surveillance, Epidemiology and End Results Analysis

“…24 Incidences of CHF in longterm HL survivors have been shown to be 10-fold higher for those receiving treatment before the age of 40 and at followup after 20 years. 4 The same study found these rates to be even higher in patients with a family history of heart disease. Similar to our study, the period 20 years after treatment appears to be when most cardiac events occur.…”

“…[1][2][3][4][5] A large European analysis found significantly higher rates of cardiovascular mortality after childhood cancer treatment in people receiving a cumulative anthracycline dose greater than 360 mg/m 2 and radiation doses greater than 5 Gy. 5 Numerous other studies describe long-term cardiac toxicities, including myocardial infarction, decreased ventricular function, valvular disorders, and congestive heart failure.…”

Evidence-based focused review of the role of radiation therapy in the treatment of early-stage Hodgkin lymphoma

“…At present, long-term estimates of risk, up to 20 years after therapy, are derived from large cohort studies of patients receiving predominantly EFRT. [36][37][38][39] Late effects of more modern approaches can ideally be captured in the context of the cooperative group trials that informed this review. 40,41 Meta-analysis of the studies included in this review would have increased statistical power to compare rates of late events between treatment approaches, but these trials were too clinically heterogeneous for this to be undertaken.…”