Hodgkin’s lymphoma survivors carry high disease burden from SMN, CVD
Survivors of Hodgkin’s lymphoma (HL) are at greater risk of developing subsequent malignant neoplasm (SMN) and cardiovascular disease (CVD), according to a study.
The study included 2,908 5-year HL survivors (median age at treatment, 27.3 years). Majority of patients were treated with radiotherapy alone (27.1 percent) or in combination with chemotherapy (65.9 percent). Among those who underwent radiotherapy, 25.7 percent received subtotal nodal irradiation, 24.5 percent received mantle field irradiation and 16.2 percent received other supradiaphragmatic radiation fields.
Over a median follow-up of 22 years, 888 survivors developed SMNs and 1,153 developed CVDs. The 40-year cumulative incidence of developing either SMN or CVD was 68 percent, while that of developing both SMN and CVD was 17 percent. The mean cumulative count of all SMN and CVD events was 1.2 events per patient.
Survivors who developed a solid malignancy had similar 15-year risk of developing another subsequent malignancy vs a CVD (15 percent vs 15 percent). On the other hand, survivors who developed a CVD had a higher 15-year risk of developing another CVD vs a subsequent malignancy (46 percent vs 15 percent).
On multivariable Cox regression analysis, radiotherapy emerged as the strongest risk factor for developing both SMN and CVD.
Researchers pointed out that HL survivors diagnosed with SMN or CVD also have a high risk of subsequent events, highlighting the importance of an expertise in cardio-oncology in the follow-up care of this population.