Risk of cardiovascular disease in patients with classical Hodgkin lymphoma: a Danish nationwide register-based cohort study

The risk of cardiovascular disease (CVD) in patients with classical Hodgkin lymphoma (cHL) undergoing contemporary treatment is unclear. Methods: All patients with cHL ≥18 years at diagnosis treated with doxorubicin-containing chemotherapy between 2000-2022 were matched with comparators in a 1:5 ratio on birth year, sex, and Charlson Comorbidity Index at time of matching (score of 0 or ≥1). The cause-specific cumulative incidence of a composite of CVDs and corresponding 95% confidence intervals (CIs) were computed with death and lymphoma relapse as competing events using the Aahlen-Johansen estimator. Results: A total of 1,905 patients and 9,525 comparators with a median follow-up of 10 years (interquartile range, IQR: 5.9-17.4). Median age was 39 years (IQR: 27-56), median cumulative doxorubicin dose was 250 mg/m2 (IQR: 200-300). The CVD cumulative incidences were 4.7% (95% CI: 3.6-5.7) for patients vs. 2.6% (95% CI: 2.3-2.9) for comparators at 5 years, 8.9% (95% CI: 7.2-10.5) vs. 5.5% (95% CI: 4.9-6.0) at 10 years, and 17.0% (95% CI: 14.1-19.9) vs. 8.2% (95% CI: 7.4-9.0) at 15 years. Conclusions: CVD remains a substantial effect after contemporary treatment for cHL, suggesting that awareness of symptoms and a low threshold for referral to diagnostic examination are still important measures during survivorship.