In a study reported in the Journal of Clinical Oncology, de Vries et al developed risk models for predicting the development of coronary heart disease and heart failure in patients treated for Hodgkin lymphoma.
Study Details
The prediction models were developed in a Dutch cohort of 1,433 5-year survivors treated between 1965 and 2000. Patients were aged 18 to 50 years at the time of their diagnosis.
Key Findings
After a median follow-up of 24 years, 341 survivors had developed coronary heart disease and 102 had heart failure.
In a simple model for coronary heart disease, male sex, smoking, increasing age at time of treatment, and receipt of mediastinal or mantle field radiotherapy were associated with increased risk of developing coronary heart disease. In a model adding treatment doses, risk was also increased with increased radiotherapy dose. The receiver operating characteristic area under the curve values were 0.73 (95% confidence interval [CI] = 0.69–0.77) for the simple model and 0.74 (95% CI = 0.70–0.77) for the dose model for development of coronary heart disease at 20 years and 0.73 (95% CI = 0.71–0.76) and 0.73 (95% CI = 0.70–0.76) at 30 years. Depending on the presence of risk factors, the 30-year risk of coronary heart disease ranged from 4% to 78%.
In a simple model for heart failure, increasing age at treatment, mediastinal or mantle field radiotherapy, and anthracycline-containing chemotherapy were associated with an increased risk of developing heart failure. In the dose model, increasing doses of radiotherapy and anthracyclines were also associated with increased risk. Area under the curve values were 0.71 (95% CI = 0.64–0.79) for the simple model and 0.70 (95% CI = 0.64–0.72) for the dose model at 20 years and 0.69 (95% CI = 0.64–0.75) and 0.68 (95% CI = 0.62–0.74) at 30 years. Depending on the presence of risk factors, the 30-year risk for heart failure ranged from 3% to 46%.
The coronary heart disease models were validated in a Canadian cohort of 708 survivors treated between 1988 and 2004 and aged 18 to 50 years at diagnosis. Area under the curve values were 0.73 to 0.74.
The simple and dose model calculators for coronary heart disease and heart failure are available online on the Evidencio Medical Decision Support platform.
The investigators concluded, “We developed and validated prediction models for coronary heart disease and heart failure with good overall calibration and moderate discrimination. These models can be used to identify Hodgkin lymphoma survivors who might benefit from targeted screening for cardiovascular disease and early treatment for cardiovascular disease risk factors.”
Flora E. van Leeuwen, PhD, of the Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Dutch Cancer Society. For full disclosures of the study authors, visit ascopubs.org.
