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. 2024 Apr 4;10(1):19.
doi: 10.1186/s40959-024-00222-4.

Long-term cardiac effects of modern treatment for Hodgkin's lymphoma

Anders W Bjerring  1   2 , Knut Hb Smeland  3 , Thomas Stokke  1   2 , Kristina H Haugaa  1   2 , Espen Holte  4 , Assami Rösner  5   6 , Cecilie E Kiserud  3 , Thor Edvardsen  1   2 , Sebastian Imre Sarvari  7   8
Affiliations

Long-term cardiac effects of modern treatment for Hodgkin's lymphoma

Anders W Bjerring et al. Cardiooncology. .

Abstract

Background: Hodgkin's lymphoma (HL) is a hematological malignancy that affects both children and young adults. Traditional treatment is associated with a life-time prevalence of cardiac disease exceeding 50%. In the late 1990s protocols were modified to reduce cancer therapy-related adverse cardiac effects. This study aimed to assess the long-term impact of advances in treatment protocols on the cardiac health of HL survivors (HLS).

Methods: HLS (n = 246) treated between 1997 and 2007 with anthracycline-based chemotherapy in three centers in Norway were included. Of these, 132 (53%) had also received mediastinal radiotherapy. HLS were compared to controls (n = 58) recruited from the general population and matched for sex, age, smoking status, and heredity for coronary artery disease. All subjects underwent echocardiography, clinical assessment, and blood sampling.

Results: The HLS were 46 ± 9 years old and had been treated 17 ± 3 years before inclusion in the study. There was no significant difference between HLS and controls in ejection fraction (EF) (58%±5 vs. 59%±4, p = 0.08) or prevalence of heart failure. HLS treated with both anthracyclines and mediastinal radiotherapy (AC + MRT) had slightly worse left ventricular global longitudinal strain than controls (-19.3 ± 2.5% vs. -20.8 ± 2.0%, p < 0.001), but those treated with only anthracyclines did not. HLS treated with AC + MRT had a higher prevalence of valve disease than those treated only with anthracyclines (12% vs. 4%, p < 0.05).

Conclusions: HLS treated with anthracyclines after the late 1990s have similar cardiac function and morphology as age-matched controls, apart from higher rates of valvular disease in those who also underwent mediastinal radiotherapy.

Keywords: Cancer survivorship; Cardiotoxicity; Echocardiography; Hodgkin’s lymphoma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient recruitment and selection
Fig. 2
Fig. 2
Comparison of Echocardiographic Parameters. (A)There was no difference in ejection fraction between study groups. (B) Hodgkin’s lymphoma survivors had a higher prevalence of borderline low or low global longitudinal strain. (C) Patients receiving both anthracycline-based chemotherapy and mediastinal radiotherapy had a higher prevalence of valve disease. P-values are derived from simple one-way ANOVA for continuous variables and χ2-test for categorical variables. AC, Anthracycline-based chemotherapy; AC + MRT, Anthracycline-based chemotherapy and mediastinal radiotherapy; EF, ejection fraction; GLS, global longitudinal strain; LV, left ventricle
See this image and copyright information in PMC

References

    1. van Nimwegen FA, Schaapveld M, Janus CP, et al. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. 2015;175:1007–17. doi: 10.1001/jamainternmed.2015.1180. - DOI - PubMed
    1. Kiserud CE, Loge JH, Fosså A, Holte H, Cvancarova M, Fosså SD. Mortality is persistently increased in Hodgkin’s lymphoma survivors. Eur J Cancer. 2010;46:1632–9. doi: 10.1016/j.ejca.2010.02.010. - DOI - PubMed
    1. Boyne DJ, Mickle AT, Brenner DR, et al. Long-term risk of cardiovascular mortality in lymphoma survivors: a systematic review and meta-analysis. Cancer Med. 2018;7:4801–13. doi: 10.1002/cam4.1572. - DOI - PMC - PubMed
    1. Maraldo MV, Brodin NP, Aznar MC, et al. Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma. Annals Oncology: Official J Eur Soc Med Oncol. 2013;24:2113–8. doi: 10.1093/annonc/mdt156. - DOI - PubMed
    1. Maraldo MV, Brodin NP, Vogelius IR, et al. Risk of developing cardiovascular disease after involved node radiotherapy versus mantle field for Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2012;83:1232–7. doi: 10.1016/j.ijrobp.2011.09.020. - DOI - PubMed

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