Long-term cardiac morbidity in adolescent and young adult survivors of classical Hodgkin lymphoma: the British Columbia experience

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Adolescents and young adults (AYA) with classical Hodgkin lymphoma (cHL) have excellent survival outcomes. However, the late effects of treatment, including cardiovascular disease (CVD), can impact long-term disease-free morbidity and mortality. Using population-level administrative data, we evaluated rates of CVD in 2-year AYA survivors of cHL, aged 16-39 years, treated with ABVD or equivalent chemotherapy, with or without radiotherapy (RT). With a median follow up of 17 years (range 2.3-29 years), risk of CVD was 2.9-fold higher relative to controls, with a 5.2-fold risk of heart failure (HF) and 2.4-fold risk of ischemic heart disease (IHD). Risk of HF was associated with anthracycline-containing chemotherapy regimens alone or with combined modality therapy; whereas higher IHD risk was identified only in those treated with RT. At 20 years after the most recent cHL diagnosis or relapse, the cumulative incidence of HF was 4.3% in cases versus 0.8% in controls, and for IHD was 8.3% in cases versus 2.8% in controls. Treatment after 2005 using a PET scan guided approach reduced the overall use of RT (56.0% before 2005 vs. 14.9% 2005 and after), and was associated with a lower 15-year cumulative incidence of IHD (before 2005: 3.4% [95%CI: 1.8-5.1%]; 2005 and after: 0.7% [95%CI: 0-1.7%]) with the latter era comparable to controls; (1.6% [95%CI: 1.3-1.9%]). cHL survivors had increased 20-year cumulative mortality above that of age-matched controls (5.0% vs. 2.0%). These results can inform surveillance strategies, screening guidelines, and recommendations for risk factor modification for AYA cHL survivors.

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