For Early-Stage cHL Survivors, CVD Has Surpassed Neoplasms as Leading Cause of Death

Researchers are underscoring the long-term risk of mortality from cardiovascular disease (CVD) among survivors of early-stage classic Hodgkin lymphoma (cHL), encouraging more effective approaches for reducing the risk of CVD-associated mortality among these patients.

According to the group, CVD has, over time, becoming the leading cause of death for these patients with early-stage disease, surpassing the risk of death from cHL and other cancers.

The multicenter study of nearly 16,000 patients diagnosed with cHL over 3 decades (1983-2015) showed that for nearly all patients with stage 1 or stage 2 disease, CVD carried the highest cumulative incidence of mortality over time.

“The CVD [proportional mortality ratio] exceeded that of cHL and other neoplasms with time. This seemed to be opposite to the previous studies that have reported that the proportion of patients who died from cardiovascular disease was lower than that from either HL or other neoplasm,” wrote the researchers. “Indeed, previous studies only considered the CVD PMR for the entire population rather than analyzing the variation of PMR in different follow-up intervals; therefore, our results clearly reflected the temporal trend of PMR of CVD among cHL survivors.”

The researchers found that over the study period, the PMR of cHL decreased significantly while the PMR of CVD dropped slowly, or even remained unchanged, among certain groups of patients. At approximately 60 and 120 months of follow-up, the PMR of CVD exceeded that of cHL regardless of age at diagnosis, race, sex, and surgery status for patients with stage 1 and stage 2 disease, respectively.

Findings also included a higher risk for CVD among patients with stage 1 or disease compared with the general population. This finding was consistent across all follow-up intervals (1983-1992, 199 -2002, and 2003-2015), with absolute excess risk reaching 48.5 among patients with stage 1 disease.

“To our knowledge, we were the first to evaluate the [standardized mortality ratio] of CVD across different follow-up intervals. SMR analysis revealed that patients with stage I or stage II disease experienced higher a risk of CVD mortality than the general population, in almost all follow-up intervals,” explained the researchers. “This was consistent with the results of the entire cHL population observed in previous studies; however, the SMR for CVD decreased compared with historical research. Meanwhile, we observed that some patients in advanced stages are less likely to experience CVD mortality compared with the general population.”

The researchers found that the cumulative incidence of mortality from cHL was significantly higher among patients with stage 3 or 4 disease than among the patients with early-stage disease.

Reference

Lu Z, Teng Y, Ning X, Wang H, Feng W, Ou C. Long-term risk of cardiovascular disease mortality among classic Hodgkin lymphoma survivors. Cancer. Published online July 25, 2022. doi: 10.1002/cncr.34375