High Cumulative Burden of Cardiovascular Morbidity in Young Survivors of Hodgkin Lymphoma

Key Points

  • The cumulative burden of any grade cardiovascular conditions was twice as high in survivors of Hodgkin lymphoma than in controls.
  • The cumulative burden of grade 3 to 5 conditions was approximately 5 times higher in survivors.

In an analysis from the St. Jude Lifetime Cohort Study reported in The Lancet Oncology, Bhakta et al found a high cumulative burden of cardiovascular morbidity among pediatric, adolescent, and young adult survivors of Hodgkin lymphoma.

Study Details

The study involved data from 670 survivors of Hodgkin lymphoma treated at St. Jude Children’s Research Hospital who reached 18 years of age and were at least 10 years postdiagnosis. Outcomes in the survivors were compared with those in 272 age- and sex frequency-matched community controls in a St. Jude cohort aged 18 years at the time of assessment.

Cumulative Burden

By age 50 years, 45.5% of survivors vs 15.7% of community controls had experienced at least 1 grade 3 to 5 cardiovascular condition. Survivors experienced a cumulative burden of 430.6 grade 1 to 5 and 100.8 grade 3 to 5 cardiovascular conditions per 100 survivors, compared with 227.4 and 17.0 conditions per 100 controls, respectively. The excess grade 3 to 5 condition burden among survivors was mainly attributable to increased cases of myocardial infarction and structural heart defects. A high cardiac radiation dose (≥ 35 Gy), but not a high anthracycline dose, was associated with an increased grade 3 to 5 cardiovascular burden.

The investigators concluded: “The true effect of cardiovascular morbidity in paediatric, adolescent, and young adult survivors of Hodgkin’s lymphoma is reflected in the cumulative burden. Survivors aged 50 years will experience more than two times the number of chronic cardiovascular health conditions and nearly five times the number of more severe (grade 3–5) cardiovascular conditions compared with community controls and, on average, have one severe, life-threatening, or fatal cardiovascular condition. The cumulative burden metric provides a more comprehensive approach for assessing overall morbidity compared with currently used cumulative incidence based analytic methodologies and will assist clinical researchers when designing future trials and refining general practice screening guidelines.”

The study was funded by the National Cancer Institute, St Baldrick’s Foundation, and the American Lebanese Syrian Associated Charities.

Nickhill Bhakta, MD, of St. Jude Children’s Research Hospital, is the corresponding author of The Lancet Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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