Key result
Hodgkin's lymphoma survivors treated with modern anthracycline-based protocols had similar ejection fractions to controls, but demonstrated a 4.4-fold higher odds of borderline or impaired global longitudinal strain.
Why the study?
Traditional treatment for Hodgkin's lymphoma is associated with a life-time prevalence of cardiac disease exceeding 50%, but the long-term cardiac impact of modern treatment protocols is unclear.
Does modern anthracycline-based chemotherapy with or without mediastinal radiotherapy affect long-term cardiac outcomes in Hodgkin's lymphoma survivors compared to matched controls?
Cross-Sectional (n=304)
Yes
Does modern anthracycline-based chemotherapy with or without mediastinal radiotherapy affect long-term cardiac outcomes in Hodgkin's lymphoma survivors compared to matched controls?
Odds Ratio: 4.4 (95% CI 1.3–14.9)
Absolute Event Rate: 20% vs 5.6%
p-value: p=<0.05
Modern anthracycline-based treatment for Hodgkin's lymphoma does not significantly impair long-term ejection fraction, though the addition of mediastinal radiotherapy is associated with worse global longitudinal strain and increased valvular disease.
Cardiac monitoring remains warranted in HL survivors; leaves open whether protocol changes have meaningfully lowered long-term risks.
Background: Hodgkin’s lymphoma (HL) is a hematological malignancy that affects both children and young adults. Traditional treatment is associated with a life-time prevalence of cardiac disease exceeding 50%. In the late 1990s protocols were modified to reduce cancer therapy-related adverse cardiac effects. This study aimed to assess the long-term impact of advances in treatment protocols on the cardiac health of HL survivors (HLS). Methods: HLS (n=246) treated between 1997 and 2007 with anthracycline-based chemotherapy in three centers in Norway were included. Of these, 132 (53%) had also received mediastinal radiotherapy. HLS were compared to controls (n=58) recruited from the general population and matched for sex, age, smoking status, and heredity for coronary artery disease. All subjects underwent echocardiography, clinical assessment, and blood sampling. Results: The HLS were 46±9 years old and had been treated 17±3 years before inclusion in the study. There was no significant difference between HLS and controls in ejection fraction (EF) (58%±5 vs. 59%±4, p=0.08) or prevalence of heart failure. HLS treated with both anthracyclines and mediastinal radiotherapy (AC+MRT) had slightly worse left ventricular global longitudinal strain than controls (‑19.3±2.5% vs. -20.8±2.0%, p<0.001), but those treated with only anthracyclines did not. HLS treated with AC+MRT had a higher prevalence of valve disease than those treated only with anthracyclines (12% vs. 4%, p<0.05). Conclusions: HLS treated with anthracyclines after the late 1990s have similar cardiac outcomes as age-matched controls, apart from higher rates of valvular disease in those who also underwent mediastinal radiotherapy.
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Bjerring et al. (2024) conducted a cross-sectional in Hodgkin's lymphoma survivors (n=304). Anthracycline-based chemotherapy with or without mediastinal radiotherapy vs. Matched controls from the general population was evaluated on Borderline or impaired global longitudinal strain (GLS >-18.0%) (OR 4.4, 95% CI 1.3-14.9, p=<0.05). Hodgkin's lymphoma survivors treated with modern anthracycline-based protocols had similar ejection fractions to controls, but demonstrated a 4.4-fold higher odds of borderline or impaired global longitudinal strain.
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