CV morbidity burden high for childhood Hodgkin’s lymphoma survivors
medwireNews: Paediatric, adolescent and young adult survivors of Hodgkin’s lymphoma are likely to have a substantial cardiovascular (CV) disease burden in their later life, research suggests.
The team led by Nickhill Bhakta (St Jude Children’s Research Hospital, Memphis, Tennessee, USA) explains that long-term childhood survivors have an elevated risk of CV disease as a result of curative therapy-related exposures.
To quantify the total disease burden, the researchers devised a novel statistical method – the cumulative burden metric – which they say better captures the distribution and magnitude of morbidity by considering all CV conditions that have occurred thus far in the patient’s lifetime.
The approach was applied to 348 participants of the St Jude Lifetime Cohort Study (SJLIFE) that follows up childhood cancer survivors to assess long-term health outcomes and to 322 patients treated at St Jude Children’s Research Hospital who were not part of the study. Outcomes in these individuals, all of whom had reached 18 years of age and were at least 10-year survivors of Hodgkin’s lymphoma, were compared with those in 272 age and gender frequency-matched SJLIFE community controls.
Survivors were significantly more likely to experience at least one grade 3–5 CV event at age 50 relative to controls, with cumulative incidence rates of 45.5% versus 15.7%. However, the rates of grade 1–2 conditions were comparable.
The cumulative burden of any grade and grade 3 or worse CV disease was also significantly higher for survivors by age 50 years than for community controls, at 430.6 versus 227.4 events per 100 individuals and 100.8 versus 17.0 events per 100 individuals, respectively.
Bhakta et al report that the major contributors to the excess grade 3–5 cumulative burden in cancer survivors were myocardial infarction and structural heart defects, while the cumulative burden of dyslipidaemia and essential hypertension was similar for the two groups.
They also found that exposure to high versus low doses of cardiac radiation (≥35 vs <15 Gy) was significantly more likely to result in CV conditions of a higher grade, while such an association did not exist for increased anthracycline doses.
Therefore, “it is important for clinicians to recognise these risks when screening survivors treated with historical protocols when radiation doses of 35 Gy or higher were routinely used”, the investigators write in The Lancet Oncology.
And they conclude: “As front-line paediatric clinical cancer trials continue to include late-effect objectives and survivor screening guidelines continue to evolve, we propose that incorporation of the cumulative burden metric into future survivorship analyses will provide a more clinically relevant assessment of treatment-related morbidity.”
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