Survivors of Hodgkin lymphoma at risk for long-term cardiovascular toxicities
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Some survivors of Hodgkin lymphoma included in the Mass General Brigham YOUNG-MI registry experienced a myocardial infarction before age 50 years, according to a research letter published in JACC: CardioOncology.
In addition, patients with Hodgkin lymphoma had significantly higher all-cause and cardiovascular mortality compared with a matched cohort without a history of noncutaneous malignancy, researchers noted.
“It is well-known that survivors of Hodgkin lymphoma can develop premature coronary artery disease due to cardiotoxicity from their cancer treatment. However, less is known about outcomes after myocardial infarction in young Hodgkin lymphoma survivors. We aimed to study this by leveraging the Mass General Brigham YOUNG-MI registry,” Sanjay Divakaran, MD, researcher in the division of cardiovascular medicine and cardiovascular imaging program at Brigham and Women’s Hospital, told Healio.
The retrospective cohort study included 2,097 patients who experienced a first type 1 myocardial infarction at or before age 50 years between 2000 and 2016.
Investigators sought to assess long-term outcomes of survivors with primary outcomes of all-cause and cardiovascular mortality. They then generated a matched cohort without a history of noncutaneous malignancy who also were included in the registry.
Results showed 1.3% of the overall cohort had a history of Hodgkin lymphoma before their first myocardial infarction. All 27 of these individuals underwent mediastinal radiation, and more than half (59.3%) also received chemotherapy.
Among the 26 individuals for whom year of treatment completion was known, five underwent radiation therapy during the 1970s, 13 in the 1980s, six in the 1990s and two in the 2000s.
During median follow-up of 10.9 years, researchers found patients with Hodgkin lymphoma had significantly higher all-cause mortality (HR = 6.33; 95% CI, 2.48-16.15) and cardiovascular mortality (HR = 7.71; 95% CI, 2.57-23.15) compared with the matched cohort, after adjustment for obesity.
“The results from our study underscore the importance of screening for coronary artery disease among survivors of Hodgkin lymphoma to identify opportunities for primary prevention of coronary artery disease. The data also reinforce the need for aggressive secondary prevention measures after myocardial infarction among survivors of Hodgkin lymphoma to reduce long-term mortality,” Divakaran said. “We will soon start recruiting survivors of Hodgkin lymphoma in a study involving established and novel cardiovascular imaging biomarkers to better understand the prevalence of coronary artery disease in this population. Our ultimate goal is to improve not only diagnosis but also prognosis by positively impacting primary prevention.”
For more information:
Sanjay Divakaran, MD, can be reached at Brigham and Women’s Hospital, 75 Francis St., 70FR-5-5140, Boston, MA 02115; email: sdivakaran@bwh.harvard.edu.
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