Excessive All-Cause and Second Primary Malignancy-Related Mortality and Frequent Late Morbidity in Hodgkin Lymphoma Patients Treated During Adulthood
In a single-institution study reported in the Journal of the National Cancer Institute, Matasar et al found that Hodgkin lymphoma patients treated during adulthood were at increased risk of all-cause and second primary malignancy mortality compared with SEER (Surveillance, Epidemiology, and End Result) normative data and had high rates of late morbidity.
Study Details
The study involved data from 746 adults treated on a first-line trial at Memorial Sloan Kettering Cancer Center from 1975 to 2000. Survivors completed a detailed survey describing their physical and mental health, with a severity score (grades 1–4, ranging from mild to life-threatening or disabling) being assigned to self-reported conditions.
Mortality
At median follow-up of 22 years, 227 patients (30.4%) had died; of them, 107 (47.1%) died of Hodgkin lymphoma and 120 (52.9%) died of other causes, including second primary malignancies (n = 52, 22.9%) and cardiovascular disease (n = 27, 11.9%). Compared with SEER normative data, the risk for all-cause mortality was increased across the duration of follow-up including follow-up of < 14, 14 to 23, and > 23 years. Among all patients, the total risk ratio was 4.12 (95% confidence interval [CI] = 3.60–4.69), including risk ratios of 4.32 (95% CI = 3.48–5.31) among women and 3.99 (95% CI = 3.35–4.72) among men. The total risk ratio for second primary malignancy mortality was 2.86 (95% CI = 2.14–3.75) among all patients.
Morbidity
Among survivors, late morbidity data were available for 238 patients (45.9%). At least one morbidity was reported by 94.1%, with 47.5% reporting one or more grade 3 or 4 morbidity and 20.2% reporting two or more grade 3 morbidities. Common morbidities included endocrine (68.5%), cardiovascular (54.6%), and pulmonary (21.4%) diseases and nonfatal second malignancy (23.1%). Subjective depression, anxiety, other psychiatric illness, or multiple psychiatric morbidities requiring psychotherapy or medical therapy were reported by 22.3%. Fear of disease recurrence was also frequently reported.
The investigators concluded: “Among a large cohort of patients treated for [Hodgkin lymphoma] with extensive follow-up, risk of late mortality from causes other than [Hodgkin lymphoma] and prevalence of late medical morbidity are high. Guidelines for prevention, screening, and management of late effects in adult survivors of [Hodgkin lymphoma] are needed.
Matthew J. Matasar, MD, MS, of Memorial Sloan Kettering Cancer Center, is the corresponding author of the Journal of the National Cancer Institute article.
The study was supported by the Mortimer J. Lacher Fellowship of The Lymphoma Foundation, Adam Spector Fund for Hodgkin’s Research, Ernest and Jeanette Dicker Charitable Foundation, and Mr. Daniel Moon and Family philanthropic fund.
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