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Late cardiotoxicity after treatment for Hodgkin lymphoma

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Berthe M P Aleman
  • Alexandra W van den Belt-Dusebout
  • De Bruin, Marie Louise (Marieke)
  • Mars B van 't Veer
  • Margreet H A Baaijens
  • Jan Paul de Boer
  • Augustinus A M Hart
  • Willem J Klokman
  • Marianne A Kuenen
  • Gabey M Ouwens
  • Harry Bartelink
  • Flora E van Leeuwen

We assessed cardiovascular disease (CVD) incidence in 1474 survivors of Hodgkin lymphoma (HL) younger than 41 years at treatment (1965-1995). Multivariable Cox regression and competing risk analyses were used to quantify treatment effects on CVD risk. After a median follow-up of 18.7 years, risks of myocardial infarction (MI) and congestive heart failure (CHF) were strongly increased compared with the general population (standardized incidence ratios [SIRs] = 3.6 and 4.9, respectively), resulting in 35.7 excess cases of MI and 25.6 excess cases of CHF per 10 000 patients/year. SIRs of all CVDs combined remained increased for at least 25 years and were more strongly elevated in younger patients. Mediastinal radiotherapy significantly increased the risks of MI, angina pectoris, CHF, and valvular disorders (2- to 7-fold). Anthracyclines significantly added to the elevated risks of CHF and valvular disorders from mediastinal RT (hazard ratios [HRs] were 2.81 and 2.10, respectively). The 25-year cumulative incidence of CHF after mediastinal radiotherapy and anthracyclines in competing risk analyses was 7.9%. In conclusion, risks of several CVDs are 3- to 5-fold increased in survivors of HL compared with the general population, even after prolonged follow-up, leading to increasing absolute excess risks over time. Anthracyclines further increase the elevated risks of CHF and valvular disorders from mediastinal radiotherapy.

OriginalsprogEngelsk
TidsskriftBlood
Vol/bind109
Udgave nummer5
Sider (fra-til)1878-86
Antal sider9
ISSN0006-4971
DOI
StatusUdgivet - 1 mar. 2007
Eksternt udgivetJa

ID: 164620015