Myocardial Infarction Mortality Risk After Treatment for Hodgkin Disease: A Collaborative British Cohort Study

Swerdlow, Anthony; Higgins, Craig; Smith, Paul J.; Cunningham, David; Hancock, Barry W.; Horwich, A.; Hoskin, Peter; Lister, Andrew; Radford, John; Rohatiner, A. Z. S.; Linch, David C.

doi:10.1093/jnci/djk029

Cited by 406 publications

(237 citation statements)

References 17 publications

Supporting

Mentioning

220

Contrasting

Unclassified

Order By: Relevance

“…Several studies of cause‐specific mortality in survivors of Hodgkin lymphoma diagnosed in childhood or early adult life have been carried out,19, 20, 21 and the risk of hospitalisation among survivors of all types of cancer diagnosed in adolescence and young adulthood has been studied in other populations 22, 23, 24, 25. Other studies specifically of survivors of Hodgkin lymphoma diagnosed in young adulthood have usually reported on specific risks of second cancers11, 26, 27, 28, 29, 30, 31, 32, 33 or cardiovascular diseases 12, 34, 35, 36. The results of our study are in agreement with their findings.…”

Section: Discussionmentioning

confidence: 99%

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

et al. 2017

View full text Add to dashboard Cite

In the present study, we report on the full range of physical diseases acquired by survivors of Hodgkin lymphoma diagnosed in adolescence or young adulthood. In a Danish nationwide population‐based cohort study, 1,768 five‐year survivors of Hodgkin lymphoma diagnosed at ages 15–39 years during 1943–2004 and 228,447 comparison subjects matched to survivors on age and year of birth were included. Hospital discharge diagnoses and bed‐days during 1977–2010 were obtained from the Danish Patient Register for 145 specific disease categories gathered in 14 main diagnostic groups. The analysis was conducted separately on three subcohorts of survivors, that is, survivors diagnosed 1943–1976 for whom we had no information on rehospitalisation for Hodgkin lymphoma and survivors diagnosed 1977–2004, split into a subcohort with no expected relapses and a subcohort for whom a rehospitalisation for Hodgkin lymphoma indicated a relapse. The overall standardised hospitalisation rate ratios (RRs) were 2.0 [95% confidence interval (CI), 1.9–2.1], 1.5 (1.4–1.6) and 2.9 (2.6–3.1) respectively, and the corresponding RRs for bed‐days were 3.5 (3.4–3.5), 1.8 (1.8–1.9) and 10.4 (10.3–10.6). Highest RRs were seen for nonmalignant haematological conditions (RR: 2.6; 3.1 and 9.7), malignant neoplasms (RR: 3.2; 2.5 and 4.7) and all infections combined (RR: 2.5; 2.2 and 5.3). Survivors of Hodgkin lymphoma in adolescence or young adulthood are at increased risk for a wide range of diseases that require hospitalisation. The risk depends on calendar period of treatment and on whether the survivors were rehospitalised for Hodgkin lymphoma, and thus likely had a relapse.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…7,22,23 Two recent large cohort studies from the Netherlands and UK show an increased standardized mortality rate in CVD that is probably attributed to radiotherapy and adriamycin. 5,4 The UK study also found a significant relation to vincristin. 4 The Dutch study, which was a matched control study, found that there was a general increase in the risk for in patient care for CVD in patients treated for HL.…”

Section: Discussionmentioning

confidence: 86%

“…5,4 The UK study also found a significant relation to vincristin. 4 The Dutch study, which was a matched control study, found that there was a general increase in the risk for in patient care for CVD in patients treated for HL. 5 The comorbidity question could be answered by the prospective study as information of HL treatment and family history of CVD are collected.…”

Section: Discussionmentioning

confidence: 86%

“…[1][2][3][4] After HL and SM, CVD is the most common cause of death in this group of patients. Studies have shown that these patients have an increased risk for coronary artery disease (CAD), valvular disease, congestive heart failure (CHF), pericardial disease and sudden death.…”

mentioning

confidence: 99%

“…The risk is particularly high in patients treated before the age of 40 years. [4][5][6][7][8] If given high doses, radiotherapy (RT) damages the endothelial cells, causes fibrosis of the valves, and induces myocardial injury and cardiomyopathy. 9 Therapy with adriamycin is a known risk factors for the development of cardiomyopathy.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

Andersson

Näslund

Tavelin

et al. 2009

Intl Journal of Cancer

View full text Add to dashboard Cite

Previous studies have shown increased cardiovascular mortality as late side effects in Hodgkin lymphoma (HL) patients. This study identifies stratifying risk factors for surveillance and defines concepts for a clinical feasible and noninvasive prospective protocol for intervention of cardiovascular side effects. HL patients diagnosed between 1965 and 1995 (n 5 6.946) and their first-degree relatives (FDR) were identified through the Swedish Cancer Registry and the Swedish Multigeneration Registry. For the HL and FDR cohort, in-patient care for cardiovascular disease (CVD) was registered through the Hospital Discharge Registry, Sweden. Standard incidence ratios of developing CVD for the HL cohort were calculated. A markedly increased risk for in-patient care of CVD was observed in HL patients with HL diagnosed at age 40 years or younger and with more than 10 years follow-up. In the HL survivors, a family history of congestive heart failure (CHF) and coronary artery disease (CAD) increased the risk for these diseases. The Swedish Hodgkin Intervention and Prevention study started in 2007. In the pilot feasibility study for prospective intervention (47 patients), about 25% of the cases had side effects and laboratory abnormalities. These patients were referred to a cardiologist or general practitioner. In the prospective cohort, a positive family history for CHF or CAD could be a stratifying risk factor when setting up a surveillance model. The prospective on-going study presents an intervention model that screens and treats for comorbidity factors. This article also presents an overview of the study concept.

show abstract

Cardiovascular Disease After Hodgkin Lymphoma Treatment

et al. 2015

View full text Add to dashboard Cite

IMPORTANCE Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular diseases. It is unclear, however, how long the increased risk persists and what the risk factors are for various cardiovascular diseases. OBJECTIVES To examine relative and absolute excess risk up to 40 years since HL treatment compared with cardiovascular disease incidence in the general population and to study treatment-related risk factors for different cardiovascular diseases. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 2524 Dutch patients diagnosed as having HL at younger than 51 years (median age, 27.3 years) who had been treated from January 1, 1965, through December 31, 1995, and had survived for 5 years since their diagnosis. EXPOSURES Treatment for HL, including prescribed mediastinal radiotherapy dose and anthracycline dose. MAIN OUTCOMES AND MEASURES Data were collected from medical records and general practitioners. Cardiovascular events, including coronary heart disease (CHD), valvular heart disease (VHD), and cardiomyopathy and congestive heart failure (HF), were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS After a median follow-up of 20 years, we identified 1713 cardiovascular events in 797 patients. After 35 years or more, patients still had a 4-to 6-fold increased standardized incidence ratio of CHD or HF compared with the general population, corresponding to 857 excess events per 10 000 person-years. Highest relative risks were seen in patients treated before 25 years of age, but substantial absolute excess risks were also observed for patients treated at older ages. Within the cohort, the 40-year cumulative incidence of cardiovascular diseases was 50% (95% CI, 47%-52%). Fifty-one percent of patients with a cardiovascular disease developed multiple events. For patients treated before 25 years of age, cumulative incidences at 60 years or older were 20%, 31%, and 11% for CHD, VHD, and HF as first events, respectively. Mediastinal radiotherapy increased the risks of CHD (hazard ratio [HR], 2.7; 95% CI, 2.0-3.7), VHD (HR, 6.6; 95% CI, 4.0-10.8), and HF (HR, 2.7; 95% CI, 1.6-4.8), and anthracycline-containing chemotherapy increased the risks of VHD (HR, 1.5; 95% CI, 1.1-2.1) and HF (HR, 3.0; 95% CI, 1.9-4.7) as first events compared with patients not treated with mediastinal radiotherapy or anthracyclines, respectively. Joint effects of mediastinal radiotherapy, anthracyclines, and smoking appeared to be additive. CONCLUSIONS AND RELEVANCE Throughout their lives, HL survivors treated at adolescence or adulthood are at high risk for various cardiovascular diseases. Physicians and patients should be aware of this persistently increased risk.

show abstract

Myocardial Infarction Mortality Risk After Treatment for Hodgkin Disease: A Collaborative British Cohort Study

Abstract: The risk of death from myocardial infarction after treatment for Hodgkin disease remains high for at least 25 years. The increased risks are related to supradiaphragmatic radiotherapy but may also be related to anthracycline and vincristine treatment.

Cited by 406 publications

References 17 publications

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

Cardiovascular Disease After Hodgkin Lymphoma Treatment

Contact Info

Product

Resources

About