Myocardial infarction in young patients with Hodgkin's disease ? potential pothogenic role of radiotherapy, chemotherapy, and splenectomy

Abstract

Among a total of 2147 patients admitted to our hospital for acute myocardial infarction between 1978 and 1987, three young patients aged 24, 29, and 39 years had previously been treated for Hodgkin's disease. Staging laparotomy, including splenectomy, had been performed in all three patients. Two patients had both mediastinal irradiation (21 and 27 months before infarction) and chemotherapy. In the first patient, postmortem histologic examination of the coronary arteries revealed fibrotic changes, which were probably induced by radiotherapy. In our second patient, myocardial infarction developed 5 days after vinblastine treatment; early angiography showed thrombotic occlusion of the proximal right coronary artery, which was recanalized using the diagnostic Sones catheter. Subsequent angiography revealed normal coronary arteries. This is, to our knowledge, the first case of documented coronary artery thrombosis after treatment with vinca-alkaloids. In our third patient, neither mediastinal irradiation nor chemotherapy had been performed prior to myocardial infarction. However, a marked increase in platelet counts following splenectomy was observed in this patient. The role of radiotherapy, chemotherapy, and splenectomy with consecutive thrombocytosis as a third possible pathogenic factor for subsequent development of myocardial infarction is discussed.

Thrombotic complications in adult patients with lymphoma: a meta-analysis of 29 independent cohorts including 18 018 patients and 1149 events

“…From a total of 70 articles retrieved, 47 were excluded for one of the following reasons: review articles (n ϭ 13), [9][10][11][12][13][14][15][16][17][18][19][20][21] no data about incidence of clinical thrombotic events (n ϭ 13), [22][23][24][25][26][27][28][29][30][31][32][33][34] no distinction of type of cancer (n ϭ 9), [35][36][37][38][39][40][41][42][43] duplicated data (n ϭ 3), [44][45][46] case reports (n ϭ 7), [47][48][49][50][51][52][53] and case-control studies of patients with a first event of deep vein thrombosis (DVT) and subsequent cancer diagnosis (n ϭ 2). 54,55 In addition, studies in which the authors evaluated the incidence of thrombosis after bone marrow transplantation (n ϭ 3) [56][57]…”

Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors

“…Second malignant neoplasms, especially ALL, are also among the late effects of therapy [33,34,[37][38][39] . Antineoplastic drugs, especially anthracyclines and mediastinal radiotherapy can cause decrease in cardiac contractility, heart insufficiency, pericardial effusion, constrictive pericarditis, coronary artery disease, myocardial infarction, and arrhythmias [15][16][17][18][19]40] . Vascular narrowing and cerebrovascular accidents are also among the late complications.…”

“…Therefore, screening of cardiac functions of these individuals after ceseation of cancer treatment is particularly important and the principles for the following-up of these patients have been published [14] . Some researchers have reported higher relative risks of myocardial infarction mortality in patients treated at younger ages than in patients treated at older ages and in men than in women [15][16][17][18][19] . Other researchers have reported valvular dysfunction, carotid, subclavian and coronary artery disease and even fatality from cardiac infarction at early childhood after radiation therapy for the treatment of Hodgkin lymphoma (HL) [20][21][22][23] .…”

Radiation Therapy and Risk of Cardiovascular Disease

“…About 1% of polyps in the 6 to 9 mm range are malignant and at least 2% have high-grade dysplasia. 4 No evidence states that patients or their physicians will accept leaving polyps less than 1 cm or even less than 5 mm in place, or that CTC examinations where small polyps are seen will be treated as normal. Small polyps left in place are likely to be followed at short intervals by repeat CTC, a practice with doubtful cost-effectiveness, and with possible increased colorectal cancer and radiation risk.…”

“…3 This modification alone may have resulted in a significant reduction of the incidence of structural cardiac diseases. 4 The number of survivors in the study by Hull et al who developed significant valvular disease, and who were treated prior to the introduction of subcarinal shielding, is not known. It is possible that the increased incidence of valvular stenosis and, to some extent, coronary artery disease was due to the now outdated radiation techniques.…”