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Long-term cause-specific mortality of patients treated for Hodgkin's disease.
J Clin Oncol. 2003 Sep 15; 21(18):3431-9.JC

Abstract

PURPOSE

To assess long-term cause-specific mortality of young Hodgkin's disease (HD) patients.

PATIENTS AND METHODS

The study population consisted of 1,261 patients treated for HD before age 41 between 1965 and 1987. Follow-up was complete until October 2000. For 95% of deaths, the cause was known. Long-term cause-specific mortality was compared with general population rates to assess relative risk (RR) and absolute excess risk (AER) of death.

RESULTS

After a median follow-up of 17.8 years, 534 patients had died (55% of HD). The RR of death from all causes other than HD was 6.8 times that of the general population, and still amounted to 5.1 after more than 30 years. RRs of death resulting from solid tumors (STs) and cardiovascular disease (CVD) were increased overall (RR = 6.6 and 6.3, respectively), but especially in patients treated before age 21 (RR = 14.8 and 13.6, respectively). When these patients grew older, this elevated mortality decreased. The overall AER of death from causes other than HD increased throughout follow-up. Patients receiving salvage chemotherapy had a significantly increased RR of death from STs, compared to patients receiving initial therapy only.

CONCLUSION

The main cause of death among HD patients was lymphoma, but after 20 years, HD mortality was negligible. The RRs and AERs of death from second primary cancers (SCs) and CVDs continued to increase after 10 years. Even more than 30 years after diagnosis, HD patients experienced elevated risk of death from all causes other than HD. Increased risk of death from SCs and CVDs was found especially in patients treated before age 21, but these risks seemed to abate with age.

Authors+Show Affiliations

Aleman BM
Department of Epidemiology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
van den Belt-Dusebout AW
No affiliation info available
Klokman WJ
No affiliation info available
Van't Veer MB
No affiliation info available
Bartelink H
No affiliation info available
van Leeuwen FE
No affiliation info available

MeSH

AdultCardiovascular DiseasesCause of DeathFemaleFollow-Up StudiesHodgkin DiseaseHumansInfectionsLeukemiaMaleMiddle AgedMyelodysplastic SyndromesNeoplasms, Second PrimaryProportional Hazards ModelsRiskRisk FactorsSurvival Rate

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12885835

Citation

Aleman, Berthe M P., et al. "Long-term Cause-specific Mortality of Patients Treated for Hodgkin's Disease." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 21, no. 18, 2003, pp. 3431-9.
Aleman BM, van den Belt-Dusebout AW, Klokman WJ, et al. Long-term cause-specific mortality of patients treated for Hodgkin's disease. J Clin Oncol. 2003;21(18):3431-9.
Aleman, B. M., van den Belt-Dusebout, A. W., Klokman, W. J., Van't Veer, M. B., Bartelink, H., & van Leeuwen, F. E. (2003). Long-term cause-specific mortality of patients treated for Hodgkin's disease. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 21(18), 3431-9.
Aleman BM, et al. Long-term Cause-specific Mortality of Patients Treated for Hodgkin's Disease. J Clin Oncol. 2003 Sep 15;21(18):3431-9. PubMed PMID: 12885835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term cause-specific mortality of patients treated for Hodgkin's disease. AU - Aleman,Berthe M P, AU - van den Belt-Dusebout,Alexandra W, AU - Klokman,Willem J, AU - Van't Veer,Mars B, AU - Bartelink,Harry, AU - van Leeuwen,Flora E, Y1 - 2003/07/28/ PY - 2003/7/30/pubmed PY - 2003/10/24/medline PY - 2003/7/30/entrez SP - 3431 EP - 9 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 21 IS - 18 N2 - PURPOSE: To assess long-term cause-specific mortality of young Hodgkin's disease (HD) patients. PATIENTS AND METHODS: The study population consisted of 1,261 patients treated for HD before age 41 between 1965 and 1987. Follow-up was complete until October 2000. For 95% of deaths, the cause was known. Long-term cause-specific mortality was compared with general population rates to assess relative risk (RR) and absolute excess risk (AER) of death. RESULTS: After a median follow-up of 17.8 years, 534 patients had died (55% of HD). The RR of death from all causes other than HD was 6.8 times that of the general population, and still amounted to 5.1 after more than 30 years. RRs of death resulting from solid tumors (STs) and cardiovascular disease (CVD) were increased overall (RR = 6.6 and 6.3, respectively), but especially in patients treated before age 21 (RR = 14.8 and 13.6, respectively). When these patients grew older, this elevated mortality decreased. The overall AER of death from causes other than HD increased throughout follow-up. Patients receiving salvage chemotherapy had a significantly increased RR of death from STs, compared to patients receiving initial therapy only. CONCLUSION: The main cause of death among HD patients was lymphoma, but after 20 years, HD mortality was negligible. The RRs and AERs of death from second primary cancers (SCs) and CVDs continued to increase after 10 years. Even more than 30 years after diagnosis, HD patients experienced elevated risk of death from all causes other than HD. Increased risk of death from SCs and CVDs was found especially in patients treated before age 21, but these risks seemed to abate with age. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/12885835/Long_term_cause_specific_mortality_of_patients_treated_for_Hodgkin's_disease_ DB - PRIME DP - Unbound Medicine ER -