Second neoplasm, cardiovascular disease greatest contributors to long-term mortality in childhood cancer survivors

Castellino SM. Blood. 2010;dio:10.1182/blood-2010-04-278796.

Survivors of pediatric Hodgkin’s lymphoma are at increased mortality risk more than 20 years after diagnosis, primarily due to excess mortality from second neoplasms and cardiovascular disease, a study indicated.

Because of this excess risk, survivors of pediatric Hodgkin’s lymphoma and their physicians later in life should be aware of these specific health risks, the researchers wrote.

Data were gathered on the leading mortalities, overall and cause-specific mortality and mortality risks in 2,742 pediatric Hodgkin’s lymphoma survivors who were enrolled in the Childhood Cancer Survivor Study. Patients were diagnosed between 1970 and 1986.

Researchers calculated an excess absolute risk for death and the incidence of key medical morbidities.

They found that these survivors had a substantial excess absolute risk for mortality, at a rate of 95.5 per 10,000 person-years. Of the 2,633 members of the cohort, 500 deaths were observed. The most prevalent causes of death were Hodgkin’s lymphoma (35%), second malignant neoplasm (23%) and cerebrovascular and heart disease (14%).

Thirty year’s post-diagnosis OS was 74.1% (95% CI, 71.8%-76.6%) and was different by sex (P=.007). Risk for second malignant neoplasm also differed by sex (P<.001), at 6.3 (95% CI, 5.6-7.1) for men and 12.0 for women (95% CI, 10.4-13.8).

Finally, the researchers identified risks that increased overall mortality among these survivors. These risks included a radiation dose greater than 30 Gy, exposure to anthracycline or alkylating agents, non-breast second malignant neoplasm or a serious cardiovascular condition.

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