A late effect of Hodgkin lymphoma (HL) treatment is a 2.5-fold increased risk of coronary heart disease (CHD) in survivors who underwent mediastinal radiotherapy, according to a study published online ahead of print in the Journal of Clinical Oncology.1

The researchers conducted a nested case-control study in a cohort of 2617 5-year survivors of HL who were treated between 1965 and 1995 to identify the risk factors for CHD and to quantify the effects of radiation dose to the heart, chemotherapy, and other cardiovascular risk factors. Cases were patients in whom CHD was diagnosed at their first cardiovascular event after HL.

Interval between HL and CHD was a median of 19.0 years. CHD risk increased linearly with increasing mean heart dose (MHD) (excess relative risk [ERR]) per Gray, 7.4%, resulting in a 2.5-fold increased risk of CHD for patients who received a MHD of 20 Gy from mediastinal radiotherapy compared with patients who did not receive mediastinal radiotherapy.

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This risk appeared to decrease with each tertile of age at treatment; however, having 1 or more classic CHD risk factor (diabetes mellitus, hypertension, or hypercholesterolemia) independently increased CHD risk. The results also showed that CHD risk was decreased in patients with a high level of physical activity.

The researchers conclude that CHD risk may be reduced in HL survivors with appropriate early management of CHD risk factors and engaging in physical activity.


1. van Nimwegen FA, Schaapveld M, Cutter DJ, et al. Radiation dose-response relationship for risk of coronary heart disease in survivors of Hodgkin lymphoma [published online ahead of print November 16, 2015]. J Clin Oncol. doi:10.1200/JCO.2015.63.4444.