Cause-Specific Mortality in a Cohort of 1,435 Patients With Hodgkin Lymphoma Treated Between 1985 and 2014: A Nationwide Chilean Cohort Study

Abstract

Purpose: Hodgkin lymphoma (HL) is classified as the first malignancy to be cured by a combination of chemotherapy and radiotherapy. However, the life expectancy of HL survivors is hampered by the occurrence of late adverse events, including second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs).

Patients and methods: We investigated the causes of death in a cohort of 1,435 patients over age 15 years treated at 18 different public cancer centers in Chile.

Results: After a median follow-up of 19 years (0-37), the 5-year overall survival improved from 64% in the cohort 1985-1994 to 81% in the cohort 2009-2014 (P < .001). HL was the main cause of death in the first 10 years after treatment, whereas SMN and CVD risk peaked 10-15 years and remained raised for 30 years or longer. Cumulative incidence of deaths (CIDs) due to SMNs resulted significantly higher in patients treated with cyclophosphamide, vincristine, procarbazine, prednisone (MOPP)/MOPP-like regimens over doxorubicin, bleomycin, vinblastine, dacarbazine. CIDs due to CVDs increased from 0.4 to 4.1 at 5 and 20 years, respectively.

Conclusion: HL survivors continue to have a reduced life expectancy due to an increased risk of dying of SMNs and/or CVDs, although it was lower among patients treated in the most recent calendar period studied (2002-2014).