Hodgkin lymphoma survivors have higher risk for cardiovascular diseases

Survivors of Hodgkin lymphoma appear to be at higher risk for cardiovascular diseases and both physicians and patients need to be aware of this increased risk, according to an article published by JAMA Internal Medicine (2015; doi:10.1001/jamainternmed.2015.1180).

Hodgkin lymphoma (HL) is a curable cancer with 10-year survival rates exceeding 80%. Treatment for HL has been associated with increased risks for other cancers and cardiovascular diseases, and those later cardiovascular complications may be the consequence of radiotherapy and chemotherapy in HL treatment, according to the study background.

Flora E. van Leeuwen, PhD, of the Netherlands Cancer Institute, Amsterdam, and coauthors examined the risk for cardiovascular disease in survivors up to 40 years after HL treatment and compared it with the general population. They also studied treatment-related risk factors.

The study included 2,524 Dutch patients with HL diagnosed at younger than 51 years (median age was 27.3 years), who were treated from 1965 through 1995 and had survived for 5 years after diagnosis. The treatment for HL included mediastinal (chest area) radiotherapy and anthracycline agents for chemotherapy.

Of the 2,524 patients in the analyses, 2,052 patients (81.3%) had received mediastinal radiotherapy and 773 patients (30.6%) had received chemotherapy containing an anthracycline. After follow-up for a median 20.3 years, 1,713 cardiovascular events occurred in 797 patients and 410 of those patients (51.4%) experienced two events or more.

The most frequently occurring cardiovascular disease was coronary heart disease (CHD), with 401 patients developing it as their first event, followed by valvular heart disease (VHD, 374 events) and heart failure (HF, 140 events). The median times between Hodgkin lymphoma treatment and first cardiovascular disease events were 18 years for CHD, 24 years for VHD, and 19 years for HF, according to the results.

Compared with the general population, the authors observed 4-fold to 7-fold increased risks of CHD or HF 35 years or more after treatment for Hodgkin lymphoma, which resulted in 857 more cardiovascular events per 10,000 person years, according to the results.

The cumulative risk of any type of cardiovascular disease was 50% at 40 years after Hodgkin lymphoma diagnosis. For patients treated for Hodgkin lymphoma before they were 25 years old, the cumulative risk at 60 years or older for CHD was 20%, 31% for VHD, and 11% for HF as first events, the result indicate.

The study also found that mediastinal radiotherapy increased the risk of CHD, VHD, and HF, while anthracycline-containing chemotherapy increased the risks of VHD and HF as first events compared with patients who did not receive those cancer treatments.

"Treating physicians and patients should be aware of the persistently increased risk of cardiovascular diseases throughout life, and the results of our study may direct guidelines for follow-up of patients with HL [Hodgkin lymphoma]," the study concluded.

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