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Half of 2,524 people treated for Hodgkin lymphoma developed heart or valve disease within forty years, and the risk was still four to six times the general population's after thirty-five years.
The companion to the second-cancer cohort, from the same Dutch group. 2,524 patients diagnosed with Hodgkin lymphoma before the age of 51 (median 27.3 years) between 1965 and 1995, who survived at least five years, were followed through medical records and general practitioners, with cardiovascular events graded by the Common Terminology Criteria for Adverse Events version 4.0.
After a median follow-up of 20 years, 1,713 cardiovascular events occurred in 797 patients. At 35 years or more, the standardised incidence ratio for coronary heart disease or heart failure was still four to six times the general population rate, corresponding to 857 excess events per 10,000 person-years. The 40-year cumulative incidence of cardiovascular disease within the cohort was 50 per cent (95 per cent confidence interval 47 to 52), and 51 per cent of those affected had more than one event. For patients treated before the age of 25, cumulative incidences at 60 years or older were 20 per cent for coronary heart disease, 31 per cent for valvular heart disease and 11 per cent for heart failure as first events.
Mediastinal radiotherapy raised the risk of coronary heart disease (hazard ratio 2.7, 2.0 to 3.7), valvular heart disease (6.6, 4.0 to 10.8) and heart failure (2.7, 1.6 to 4.8). Anthracycline-containing chemotherapy raised valvular heart disease (1.5, 1.1 to 2.1) and heart failure (3.0, 1.9 to 4.7). The joint effects of mediastinal radiotherapy, anthracyclines and smoking appeared additive, which is the finding a survivor can act on.
The reason cardiac surveillance belongs in Hodgkin lymphoma survivorship care, the reason smoking cessation is a specific intervention for this group rather than general advice, and part of the reason modern protocols try to limit both mediastinal radiation and cumulative anthracycline dose.
The reason every current Hodgkin lymphoma trial is a de-escalation trial, and the reason survivors need lifelong surveillance rather than discharge at five years. It is also a warning about assuming that a gentler protocol is a safer one until a cohort has been followed long enough to say.
The dose-response curve behind breast surveillance programmes for women irradiated for Hodgkin lymphoma as teenagers or young adults, which in several countries start at 25 or eight years after radiotherapy and use magnetic resonance imaging as well as mammography.
Shares GHSG HD10, GHSG HD16, RADAR, Early-stage classical Hodgkin lymphoma (stage I to II) and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, GHSG HD16, RADAR, Early-stage classical Hodgkin lymphoma (stage I to II) and the tag lymphoma-evidence.
Shares GHSG HD16, RADAR, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, GHSG HD16, RADAR, Early-stage classical Hodgkin lymphoma (stage I to II) and the tag lymphoma-evidence.
Shares Advanced-stage classical Hodgkin lymphoma (stage III to IV), Survivorship and late effects are neglected, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Doxorubicin and the tag lymphoma-evidence.
Shares Advanced-stage classical Hodgkin lymphoma (stage III to IV), Survivorship and late effects are neglected, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Doxorubicin and the tag lymphoma-evidence.
Shares Advanced-stage classical Hodgkin lymphoma (stage III to IV), Survivorship and late effects are neglected, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Doxorubicin and the tag lymphoma-evidence.
Shares Advanced-stage classical Hodgkin lymphoma (stage III to IV), Survivorship and late effects are neglected, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Doxorubicin and the tag lymphoma-evidence.