Major complications and causes of death in patients treated for Hodgkin's disease.

Abstract

A total of 340 patients with Hodgkin's disease were evaluated for the occurrence of intercurrent fatalities after treatment with radiotherapy, chemotherapy, combined modality therapy, and salvage chemotherapy. Mean follow-up time was 76.6 months. Causes of death were compared with the expected risk, calculated from mortality statistics of the Netherlands' population. Sixty-seven patients died of progressive Hodgkin's disease, whereas 37 patients died of causes unrelated to advanced disease. Patients showed an increased risk of dying of leukemia and solid tumors (P less than .001), whereas the risk of dying of cardiovascular complications was not increased. The 10-year actuarial risk of dying of leukemia varied between 0% for patients treated with radiotherapy only and 5.7% for those needing salvage chemotherapy. The 10-year risk of dying of solid tumors was 0% for patients treated with chemotherapy and 6.5% for those receiving radiotherapy. Treatment-related fatalities were highest after combined modality therapy (P less than .025); the corresponding 10-year risk was 6.1%. Compared with younger ones, patients greater than or equal to 40 years had an increased risk of dying of causes unrelated to progressive Hodgkin's diseases. The actuarial risk of developing intercurrent fatalities at 10 years was 4.9% in patients less than 40 years, and 34.7% in those greater than or equal to 40 years (P less than .001). Compared with population based statistics, patients successfully treated for Hodgkin's disease still showed an increased risk of dying (P less than .001). Treatment modality, stage, and histologic subtype were not predictors of intercurrent death.

Three cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or epirubicin, bleomycin, vinblastine, and methotrexate (EBVM) plus extended field radiation therapy in early and intermediate Hodgkin disease: 10-year results of a randomized trial

“…34 However, EBVMm combined with high-dose extended RT was associated with a very low 10-year rate of non-Hodgkin lymphomas (1 case, ie, 0.6% Ϯ 0.6%), which is not in favor of the idea that NHLs could be part of the natural history of HD or of an underlying immunodeficiency as suggested by others. 36,37 A review on the occurrence of NHLs after HD is in keeping with our observation; combined modality therapy such as MOPP-RT was shown to result in an increased risk of NHLs compared with RT alone. 30 Moreover, it was also suggested that CTs comprising one alkylating agent resulted in lower risk of NHLs than CTs comprising 2 alkylating agents.…”

State-of-the-art Issues in Hodgkin’s Lymphoma Survivorship

“…During the first 10 years following diagnosis of HL, recurrent or refractory HL is, predictably, the leading cause of mortality, accounting for up 15%-30% of deaths [3]. However, between 12 and 15 years after initial diagnosis, mortality from other causes surpasses mortality from HL [4].…”

Staging Laparotomy in the Management of Hodgkin's Disease: Is it Still Necessary?

“…Importantly, the cohort that does not relapse after radiation therapy alone is spared the potential short-and long-term toxicities of additional chemotherapy. These toxicities include a 2% to 6% 10-to 15-year risk of developing acute leukemia [6,61,62,79,93,[101][102][103][104][105][106][107][108][109][110][111][112][113][114][115], as well as infertility [116][117][118] and cardiac and pulmonary toxicity [119][120][121][122][123].…”

“…In the absence of laparotomy, the toxicities of the various therapies require careful examination. As has been discussed, chemotherapy, particularly with the MOPP regimen, has been associated with a 2% to 6% 10-to 15-year risk of developing acute leukemia [6,61,62,79,93,[101][102][103][104][105][106][107][108][109][110][111][112][113][114][115]. If preleukemic cytogenetic abnormalities are included, then the 10-year risk climbs to 13% [138].…”