Second Lethal Events Associated with Treatment for Hodgkin's Disease: A Review of 2980 Patients Treated in a Single Mexican Institute

Avilés, Agustín; Neri, Natividad; Cuadra, Ivonne; Alvarado, Isabel; Cleto, Sérgio

doi:10.3109/10428190009065830

Cited by 14 publications

(7 citation statements)

References 22 publications

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“…Unfortunately, this is not the case despite recent advances in therapy as demonstrated in our study, wherein patients in the 1973–1992 cohort, continued to have steady increase in EMR beyond 20 years from diagnosis reaching 23.69% at 30 years from diagnosis (20‐years follow‐up of 10‐year survivors) (Figure ). This is consistent with previous large cohorts of pediatric and adult cHL patients diagnosed up to the mid‐1990s showing significantly increased risk of death even after 25 years post cancer therapy …”

Section: Discussionsupporting

confidence: 92%

Excess mortality among 10‐year survivors of classical Hodgkin lymphoma in adolescents and young adults

et al. 2017

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Adolescents and young adults (AYA) surviving classical Hodgkin lymphoma (cHL) risk long term fatal treatment-related toxicities. We utilized the Surveillance, Epidemiology and End Results (SEER) program to compare excess mortality rate (EMR-observed minus expected mortality) for 10-year survivors of AYA cHL diagnosed in 1973-1992 and 1993-2003 eras. The 15-year EMR reduced from 4.88% to 2.19% while the 20-year EMR reduced from 9.46% to 4.07% between eras. Survivors of stages 1-2 had lower EMR than survivors of stages 3-4 cHL in the 1993-2003 but not in the 1973-1992 era. There was an overall decline in risk of death between 10 and 15 years from diagnosis, driven mostly by second neoplasms and cardiovascular mortality. Despite reduction in fatal second neoplasms and cardiovascular disease with more current therapy, long term survivors of AYA cHL still have a higher risk of death than the general population highlighting the need for safer therapies.

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Section: Discussionsupporting

confidence: 92%

Excess mortality among 10‐year survivors of classical Hodgkin lymphoma in adolescents and young adults

et al. 2017

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“…23 Generally, the survival of our cohort, with a 10-year overall survival of 75%, is comparable to survival in the literature, given that this cohort consists of patients treated in the period between 1966 and 1986 and includes patients with advanced disease. 1,[3][4][5][6]8,24 Our study, which, to our knowledge, has the longest median follow-up of all mortality reports on HD patients, 10,11,18,20,[25][26][27][28][29] shows that in the first 10 years following HD, the excess mortality rate is largely due to the primary disease, while after 10 years, causes other than HD contribute most to excess mortality. Unfortunately, even after 30 years of follow-up, there was no evidence of a decline in the RR of death from causes other than HD; however, the number of person- Abbreviations: O, observed number of deaths; E, expected number of deaths; RR, relative risk; AER, absolute excess risk; RT, radiotherapy; CT, chemotherapy.…”

Section: Discussionmentioning

confidence: 95%

Long-Term Cause-Specific Mortality of Patients Treated for Hodgkin’s Disease

Aleman

Belt-Dusebout²,

Klokman³

et al. 2003

JCO

660

417

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The main cause of death among HD patients was lymphoma, but after 20 years, HD mortality was negligible. The RRs and AERs of death from second primary cancers (SCs) and CVDs continued to increase after 10 years. Even more than 30 years after diagnosis, HD patients experienced elevated risk of death from all causes other than HD. Increased risk of death from SCs and CVDs was found especially in patients treated before age 21, but these risks seemed to abate with age.

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“…Increased risks of death from radiation-associated CVD have been frequently described. [8][9][10][29][30][31][32][33][34][35][36] Radiation-induced CVD includes a wide spectrum of pathologies. 37,38 Damage of the vascular endothelium of arteries of different sizes is probably important in the explanation of radiation-induced heart disease.…”

Section: Discussionmentioning

confidence: 99%

Late cardiotoxicity after treatment for Hodgkin lymphoma

Aleman

Belt-Dusebout

Bruin

et al. 2006

Blood

649

438

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We assessed cardiovascular disease (CVD) incidence in 1474 survivors of Hodgkin lymphoma (HL) younger than 41 years at treatment . Multivariable Cox regression and competing risk analyses were used to quantify treatment effects on CVD risk. After a median follow-up of 18.7 years, risks of myocardial infarction (MI) and congestive heart failure (CHF) were strongly increased compared with the general population (standardized incidence ratios [SIRs] ‫؍‬ 3.6 and 4.9, respectively), resulting in 35.7 excess cases of MI and 25.6 excess cases of CHF per 10 000 patients/year. SIRs of all CVDs combined remained increased for at least 25 years and were more strongly elevated in younger patients. Mediastinal radiotherapy significantly increased the risks of MI, angina pectoris, CHF, and valvular disorders (2-to 7-fold). Anthracyclines significantly added to the elevated risks of CHF and valvular disorders from mediastinal RT (hazard ratios [HRs] were 2.81 and 2.10, respectively). The 25-year cumulative incidence of CHF after mediastinal radiotherapy and anthracyclines in competing risk analyses was 7.9%. In conclu IntroductionOver the past decades, survival of patients treated for Hodgkin lymphoma (HL) has improved dramatically, as a result of the development of multiagent chemotherapy (CT), more accurate radiotherapy (RT), and enhanced possibilities to reduce treatment complications. 1 Unfortunately, the improved prognosis of HL has been accompanied by long-term toxicity, such as elevated risks of second primary malignancies, 2-9 cardiovascular disease (CVD), 2,3,[8][9][10] and infections. 2,8,9 Increased mortality of cardiac disease after mediastinal radiotherapy for HL has been reported in several studies. 2,3,[8][9][10] Dose-dependent anthracycline-induced cardiotoxicity has been observed in survivors of malignancies other than HL, who were usually treated with higher anthracycline doses. 11,12 It is not known, therefore, whether anthracyclines add to the increased risk of CVD from mediastinal RT for survivors of HL. This is an important clinical question because most patients with HL now receive anthracycline-containing chemotherapy. Although a few studies reported on nonfatal cardiac events, comparisons with the general population were usually not made, because in most countries CVD incidence rates are not available. [13][14][15][16][17][18] The purpose of our study was to assess the long-term risk of various CVDs in a cohort of 1474 five-year survivors of HL treated between 1965 and 1995.Unique features of this study include long and near complete follow-up and the availability of complete treatment data, including radiation fields and chemotherapeutic agents. In addition, we compared the incidence of various CVDs with population-based reference rates from the general population, we accounted for competing risk of death from any cause, and we incorporated cardiac risk factors in the analyses. Patients and methods Data collection proceduresWe included all 5-year survivors of HL diagnosed before age 41 years (n ϭ 148...

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Second Lethal Events Associated with Treatment for Hodgkin's Disease: A Review of 2980 Patients Treated in a Single Mexican Institute

Cited by 14 publications

References 22 publications

Excess mortality among 10‐year survivors of classical Hodgkin lymphoma in adolescents and young adults

Excess mortality among 10‐year survivors of classical Hodgkin lymphoma in adolescents and young adults

Long-Term Cause-Specific Mortality of Patients Treated for Hodgkin’s Disease

Late cardiotoxicity after treatment for Hodgkin lymphoma

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