A population-based study of cardiac morbidity among Hodgkin lymphoma patients with preexisting heart disease.

The risk of cardiac hospitalization (CH) in Hodgkin lymphoma (HL) patients with preexisting heart disease was evaluated. Patients with HL were identified from a population-based registry (N = 3964). Data were abstracted from records of a randomly selected subcohort (N = 1096). A population-based registry was used to identify CH. Factors associated with CH and the incidence of CH after HL were estimated with competing risk models. Preexisting heart disease was the strongest predictor of posttreatment CH (hazard ratio = 3.98, P < .001) and significantly modified (P = .01) the effect of treatment on the risk of CH. Among patients with preexisting heart disease, treatment with mediastinal radiation therapy plus doxorubicin-based chemotherapy was associated with a 10-year incidence of CH more than 20% higher than treatment with chemotherapy alone. There is a high risk of CH after mediastinal radiation therapy plus doxorubicin-based chemotherapy among patients with preexisting heart disease; this is an important consideration when weighing treatment options, and in the follow-up of these patients.

[1]  J. Lubin,et al.  Coronary artery disease mortality in patients treated for hodgkin's disease , 2010, Cancer.

[2]  L. Specht,et al.  Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin’s lymphoma: a systematic review , 2010, Haematologica.

[3]  S. Fosså,et al.  Valvular dysfunction and left ventricular changes in Hodgkin's lymphoma survivors. A longitudinal study , 2009, British Journal of Cancer.

[4]  F. Stewart,et al.  Single-dose and fractionated irradiation promote initiation and progression of atherosclerosis and induce an inflammatory plaque phenotype in ApoE(-/-) mice. , 2008, International journal of radiation oncology, biology, physics.

[5]  F. Stewart,et al.  Radiation-induced cardiovascular injury , 2008, Radiation and environmental biophysics.

[6]  R. Tsang,et al.  Cardiac morbidity following modern treatment for Hodgkin lymphoma: Supra-additive cardiotoxicity of doxorubicin and radiation therapy , 2008, Leukemia & lymphoma.

[7]  A. Hart,et al.  Late cardiotoxicity after treatment for Hodgkin lymphoma. , 2007, Blood.

[8]  A. Horwich,et al.  Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. , 2007, Journal of the National Cancer Institute.

[9]  F. Stewart,et al.  Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE-/- mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage. , 2006, The American journal of pathology.

[10]  C. Pepine,et al.  Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. , 2003, JAMA.

[11]  S. Hancock,et al.  Asymptomatic cardiac disease following mediastinal irradiation. , 2003, Journal of the American College of Cardiology.

[12]  W. Mackillop,et al.  Evolution of treatment for Hodgkin's disease: a population-based study of radiation therapy use and outcome. , 2003, Clinical oncology (Royal College of Radiologists (Great Britain)).

[13]  Z. Qian,et al.  Effects by doxorubicin on the myocardium are mediated by oxygen free radicals. , 2001, Life sciences.

[14]  V. Diehl,et al.  Hodgkin disease: prognostic factors and treatment strategies , 2000, Current opinion in oncology.

[15]  Robert Gray,et al.  A Proportional Hazards Model for the Subdistribution of a Competing Risk , 1999 .

[16]  P. Levendag,et al.  Ischemic heart disease after mantlefield irradiation for Hodgkin's disease in long-term follow-up. , 1999, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[17]  S L Hancock,et al.  Factors affecting late mortality from heart disease after treatment of Hodgkin's disease. , 1993, JAMA.

[18]  A. Allen,et al.  The cardiotoxicity of chemotherapeutic drugs. , 1992, Seminars in oncology.

[19]  A. Buzdar,et al.  Early and delayed clinical cardiotoxicity of doxorubicin , 1985, Cancer.

[20]  J. Boivin,et al.  Coronary heart disease mortality after irradiation for Hodgkin's disease , 1982, Cancer.

[21]  D. V. Von Hoff,et al.  Risk factors for doxorubicin-induced congestive heart failure. , 1979, Annals of internal medicine.

[22]  P. Kaufmann,et al.  Cardiac risk after mediastinal irradiation for Hodgkin's disease. , 1998, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[23]  P. Rubin,et al.  Symptomatic coronary artery disease after mantle irradiation for Hodgkin's disease. , 1996, International journal of radiation oncology, biology, physics.

[24]  P. Dawes,et al.  Malignant melanoma of the external auditory meatus. , 1993, Clinical oncology (Royal College of Radiologists (Great Britain)).