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Late mortality, morbidity rates increase among survivors of adult Hodgkin's lymphoma
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Survivors of adult Hodgkin’s lymphoma face high risks for late mortality from other causes, as well as late medical morbidity, according to study results.
Medical advances have greatly improved survival for patients with Hodgkin’s lymphoma. However, as survivorship increases, the effects of late treatment-related complications are becoming more apparent.
Matthew J. Matasar, MD, a medical oncologist and hematologist at Memorial Sloan Kettering Cancer Center, and colleagues identified all patients from six consecutive clinical trials of first-line therapy for Hodgkin’s lymphoma conducted at their institution between 1975 and 2000. All six studies were phase 2 trials conducted at a single center. One arm of one study evaluated chemotherapy alone, but all other patients received combined-modality therapy for Hodgkin’s lymphoma.
The evaluated trials included 746 patients, 226 (30.3%) of whom had died. Median OS for the entire cohort was 32 years.
Of those who died, 47.1% died of Hodgkin’s lymphoma and 52.9% died of other causes. Among those who died of other causes, the most common were second primary malignancy (43.3%) or cardiovascular disease (22.5%).
The cumulative incidence of death from Hodgkin’s lymphoma increased considerably during the first 5 years, and then plateaued after 10 years at 12.8% (95% CI, 10.6-15.4). By contrast, the cumulative incidence of death from causes other than Hodgkin’s lymphoma increased steadily from 4.9% (95% CI, 3.6-6.7) at 10 years to 12% (95% CI, 9.7-14.8) at 20 years.
At 22 years after treatment in initiation, death from causes other than Hodgkin’s lymphoma surpassed Hodgkin’s lymphoma-related death.
To assess late morbidities, the researchers invited survivors to complete an 18-page questionnaire that assessed demographics, physical health and mental health. Of the 520 survivors, 238 (45.8%) consented to complete the questionnaire.
Among this group, median age at the time of treatment was 29 years (range, 14-66), median age at time of survey response was 49 years (range, 25-88), and median follow-up was 21 years (range, 5.5-32).
Nearly all (94.1%) respondents reported at least one morbidity, and nearly half (47.5%) reported at least one grade 3 or grade 4 morbidity.
Self-reported morbidities included endocrine (68.5%), cardiovascular (54.6%) or musculoskeletal (37%) problems, infectious diseases (32.4%), nonfatal second primary malignancies (23.1%) and pulmonary disease (21.4%).
About one in five (22.3%) survivors reported depression, anxiety, other psychiatric illness, or multiple psychiatric morbidities that require medical therapy or psychotherapy. Those who received radiation doses greater than 35 Gy (28.1%) were more likely to self-report psychiatric morbidity than those who received 35 Gy or less (10.8%) or no radiation (10.8%; P = .01). Younger age at treatment also was associated with self-reporting of these morbidities (P = .01).
The investigators hypothesized that most of these reported morbidities resulted from receipt of radiation therapy, which has since been modified to reduce doses and the field radiated. However, the effect of these changes will remain unknown for some time.
“It is possible that modern treatment plans may still leave us above an oncogenic threshold, resulting in delayed onset of second malignancy rather than truly mitigated lifetime risk,” Matasar and colleagues wrote. “The broader picture is one that depicts a population with numerous and sever morbidities, and at a frequency that experience suggests is far beyond the norm, with mortality rates driven by late effects as much by the original diagnosis of Hodgkin’s lymphoma. [This] supports the need for multidisciplinary care for Hodgkin’s lymphoma survivors.” – by Anthony SanFilippo
Disclosure: HemOnc Today was unable to obtain a list of relevant financial disclosures.
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