Therapy-Related Late Adverse Events in Hodgkin’s Lymphoma

Abstract

Hodgkin's lymphoma (HL) is one of the most curable hematologic diseases with an overall response rate over 80%. However, despite this therapeutic efficacy, HL survivors show a higher morbidity and mortality than other people of the same age because of long-term therapy-related events. In the last decades, many efforts have been made to reduce these effects through the reduction of chemotherapy dose, the use of less toxic chemotherapeutic agents, and the introduction of new radiation techniques. In this paper, we will describe the main long-term effects related to chemotherapy and radiotherapy for HL, the efforts to reduce toxicity made in the last years, and the clinical aspects which have to be taken into consideration in the followup of these patients.

Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review

“…ABVD and BEACOPP may also be associated with side effects not identified in this review. For example, alkylating agents in the BEACOPP regimen can affect fertility [129].…”

“…The studies identified did not report direct associations of toxicity with RT; however, many treatment-related AEs were reported that have commonly been linked to RT, including nausea, vomiting, infections, skin-related complications, cardiovascular, and pulmonary toxicity. Chemotherapy agents may exacerbate these RT-associated conditions; use of anthracyclines, such as doxorubicin, are associated with an increased risk of heart failure [129,131].…”

Personalized Management Approaches in Lymphoma

“…Lower total doses of RT and minimized fields may result in fewer toxicities, which include coronary angiopathy, secondary malignancies, thyroid abnormalities, and pulmonary toxicities. 6 In 2013, Girinsky and colleagues 7 demonstrated that the addition of PET to CT imaging improved delineation of involved node RT with increased clinical target volumes but without increased volume of radiation delivered. Therefore, the addition of PET identified, with higher precision and sensitivity, targetable lymph nodes for RT without necessitating larger radiation volumes.…”

Real-world analysis of cost, health care resource utilization, and supportive care in Hodgkin lymphoma patients with frontline failure

“…6 Patients with a bleomycin containing regimen (all three standard regimens noted earlier) are also at an increased risk of pulmonary toxicity, which can include cough and dyspnea, and lead to potential discontinuation of bleomycin with lingering effects up to a year after discontinuation. 7 The RATHL trial attempted to improve the toxicity profile of ABVD in stages II, III, and IV HL by removing bleomycin from the regimen after two cycles in patients with a negative interim PET/computed tomography (CT) scan. The trial observed a reduction in grades 3 or 4 pulmonary toxicity associated with bleomycin omission but failed to improve on the established progression-free survival rate with ABVD.…”