TY - JOUR
T1 - Long-Term Cause-Specific Mortality in Hodgkin Lymphoma Patients
AU - De Vries, Simone
AU - Schaapveld, Michael
AU - Janus, Cécile P.M.
AU - Daniëls, Laurien A.
AU - Petersen, Eefke J.
AU - Van Der Maazen, Richard W.M.
AU - Zijlstra, Josée M.
AU - Beijert, Max
AU - Nijziel, Marten R.
AU - Verschueren, Karijn M.S.
AU - Kremer, Leontien C.M.
AU - Van Eggermond, Anna M.
AU - Lugtenburg, Pieternella J.
AU - Krol, Augustinus D.G.
AU - Roesink, Judith M.
AU - Plattel, Wouter J.
AU - Van Spronsen, Dick Johan
AU - Van Imhoff, Gustaaf W.
AU - De Boer, Jan Paul
AU - Aleman, Berthe M.P.
AU - Van Leeuwen, Flora E.
N1 - Publisher Copyright:
© 2020 The Author(s). Published by Oxford University Press.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: Few studies have examined the impact of treatment-related morbidity on long-term, cause-specific mortality in Hodgkin lymphoma (HL) patients. Methods: This multicenter cohort included 4919 HL patients, treated before age 51 years between 1965 and 2000, with a median follow-up of 20.2 years. Standardized mortality ratios, absolute excess mortality (AEM) per 10 000 person-years, and cause-specific cumulative mortality by stage and primary treatment, accounting for competing risks, were calculated. Results: HL patients experienced a 5.1-fold (AEM = 123 excess deaths per 10 000 person-years) higher risk of death due to causes other than HL. This risk remained increased in 40-year survivors (standardized mortality ratio = 5.2, 95% confidence interval [CI] = 4.2 to 6.5, AEM = 619). At age 54 years, HL survivors experienced similar cumulative mortality (20.0%) from causes other than HL to 71-year-old individuals from the general population. Whereas HL mortality statistically significantly decreased over the calendar period (P <. 001), solid tumor mortality did not change in the most recent treatment era. Patients treated in 1989-2000 had lower 25-year cardiovascular disease mortality than patients treated in 1965-1976 (4.3% vs 5.7%; subdistribution hazard ratio = 0.65, 95% CI = 0.46 to 0.93). Infectious disease mortality was not only increased after splenectomy but also after spleen irradiation (hazard ratio = 2.81, 95% CI = 1.55 to 5.07). For stage I-II, primary treatment with chemotherapy (CT) alone was associated with statistically significantly higher HL mortality (P <. 001 for CT vs radiotherapy [RT]; P =. 04 for CT vs RT+CT) but lower 30-year mortality from causes other than HL (15.8%, 95% CI = 9.7% to 23.3%) compared with RT alone (36.9%, 95% CI = 34.0% to 39.8%, P =. 001) and RT and CT combined (29.8%, 95% CI = 26.8% to 32.9%, P =. 02). Conclusions: Compared with the general population, HL survivors have a substantially reduced life expectancy. Optimal selection of patients for primary CT is crucial, weighing risks of HL relapse and long-term toxicity.
AB - Background: Few studies have examined the impact of treatment-related morbidity on long-term, cause-specific mortality in Hodgkin lymphoma (HL) patients. Methods: This multicenter cohort included 4919 HL patients, treated before age 51 years between 1965 and 2000, with a median follow-up of 20.2 years. Standardized mortality ratios, absolute excess mortality (AEM) per 10 000 person-years, and cause-specific cumulative mortality by stage and primary treatment, accounting for competing risks, were calculated. Results: HL patients experienced a 5.1-fold (AEM = 123 excess deaths per 10 000 person-years) higher risk of death due to causes other than HL. This risk remained increased in 40-year survivors (standardized mortality ratio = 5.2, 95% confidence interval [CI] = 4.2 to 6.5, AEM = 619). At age 54 years, HL survivors experienced similar cumulative mortality (20.0%) from causes other than HL to 71-year-old individuals from the general population. Whereas HL mortality statistically significantly decreased over the calendar period (P <. 001), solid tumor mortality did not change in the most recent treatment era. Patients treated in 1989-2000 had lower 25-year cardiovascular disease mortality than patients treated in 1965-1976 (4.3% vs 5.7%; subdistribution hazard ratio = 0.65, 95% CI = 0.46 to 0.93). Infectious disease mortality was not only increased after splenectomy but also after spleen irradiation (hazard ratio = 2.81, 95% CI = 1.55 to 5.07). For stage I-II, primary treatment with chemotherapy (CT) alone was associated with statistically significantly higher HL mortality (P <. 001 for CT vs radiotherapy [RT]; P =. 04 for CT vs RT+CT) but lower 30-year mortality from causes other than HL (15.8%, 95% CI = 9.7% to 23.3%) compared with RT alone (36.9%, 95% CI = 34.0% to 39.8%, P =. 001) and RT and CT combined (29.8%, 95% CI = 26.8% to 32.9%, P =. 02). Conclusions: Compared with the general population, HL survivors have a substantially reduced life expectancy. Optimal selection of patients for primary CT is crucial, weighing risks of HL relapse and long-term toxicity.
UR - http://www.scopus.com/inward/record.url?scp=85107390950&partnerID=8YFLogxK
U2 - 10.1093/jnci/djaa194
DO - 10.1093/jnci/djaa194
M3 - Article
C2 - 33351090
AN - SCOPUS:85107390950
SN - 0027-8874
VL - 113
SP - 760
EP - 769
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 6
ER -