Lymphoma

Long-term cause-specific mortality in hodgkin lymphoma patients - PDF Version

de Vries S, Schaapveld M, Janus CPM, Daniëls LA, Petersen EJ, van der Maazen RWM, Zijlstra JM, Beijert M, Nijziel MR, Verschueren KMS, Kremer LCM, van Eggermond AM, Lugtenburg PJ, Krol ADG, Roesink JM, Plattel WJ, van Spronsen DJ, van Imhoff GW, de Boer JP, Aleman BMP, van Leeuwen FE.

J Natl Cancer Inst. 2020 Dec 22:djaa194. doi: 10.1093/jnci/djaa194.

BACKGROUND

Few studies examined the impact of treatment-related morbidity on long-term cause-specific mortality in Hodgkin lymphoma (HL) patients.

METHODS

This multicenter cohort included 4,919 HL patients, treated before age 51 between 1965-2000, with a median follow-up of 20.2 years. Standardised mortality ratios (SMRs), absolute excess mortality per 10,000 person-years (AEM) and cause-specific cumulative mortality by stage and primary treatment, accounting for competing risks were calculated.

RESULTS

HL patients experienced 5.1-fold (AEM = 123 excess deaths per 10,000 person-years) higher risk of death due to causes other than HL. This risk remained increased in 40-year survivors (SMR = 5.2, 95% Confidence Interval (95%CI) = 4.2-6.5; AEM = 619). At age 54 years, HL survivors experienced similar cumulative mortality (20.0%) from causes other than HL as 71-year old individuals from the general population. While HL mortality statistically significantly decreased over calendar period (p < .001), solid tumour mortality did not change in the most recent treatment era. Patients treated in 1989-2000 had lower 25-year cardiovascular disease mortality than patients treated in 1965-1976 (4.3% vs. 5.7%; sub-distribution Hazard Ratio (HR) = 0.65, 95%CI = 0.46-0.93). Infectious disease mortality was not only increased after splenectomy but also after spleen irradiation (HR = 2.81, 95%CI = 1.55-5.07). For stage I-II, primary treatment with chemotherapy alone was associated with statistically significantly higher HL mortality (p < .001 for CT vs. RT; p = .04 for CT vs. RT+CT), but lower 30-year mortality from causes other than HL (15.8%, 95%CI = 9.7%-23.3%), compared to radiotherapy alone (36.9%, 95%CI = 34.0%-39.8%; p = .001) and radiotherapy and chemotherapy combined (29.8%, 95%CI = 26.8%-32.9%; p = .02).

CONCLUSION

Compared to the general population, HL survivors have a substantially reduced life expectancy. Optimal selection of patients for primary CT is crucial, weighing risks of HL relapse and long-term toxicity.