High burden of subsequent malignant neoplasms and cardiovascular disease in long-term Hodgkin lymphoma survivors

Figures

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  Figure 1. Flowchart of subsequent malignancies and cardiovascular diseases in Hodgkin lymphoma survivors. Subsequent events are shown when the first event is coronary heart disease (CHD; including both myocardial infarction and angina pectoris, with 54% myocardial infarction among CHD as first event), gastrointestinal cancer (GI; including all malignant neoplasms of digestive organs corresponding with ICD-10 codes C15–C26) and breast cancer (ICD-10 code C50). Subsequent events included valvular heart disease (VHD), heart failure (HF), lung cancer (ICD-10 codes C33–C34), haematologic cancer (ICD-10 codes C82–C96), and other solid malignancies. Median time between subsequent events expressed in years. CVD=cardiovascular disease; SMN=subsequent malignant neoplasm

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  Figure 2. Different measures of the cumulative burden of subsequent malignancies and cardiovascular diseases in Hodgkin lymphoma survivors. (A) Overall cumulative incidence for developing subsequent malignancy (SMN) or cardiovascular disease (CVD) as first event and for developing both subsequent malignancy and cardiovascular disease. (B) Cumulative incidence for at least one, two, or three subsequent malignancies or cardiovascular diseases (irrespective of whether they concerned an SMN or CVD). (C) Overall mean cumulative count for all subsequent malignancies and cardiovascular diseases.

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  Figure 3. Cumulative incidence of subsequent malignancy and cardiovascular disease among survivors who developed a first event (solid malignancy or CVD) after Hodgkin lymphoma. (A) Cumulative incidence for developing subsequent malignancy (SMN) or cardiovascular disease (CVD) among survivors who developed a solid malignancy as first event. (B) Cumulative incidence for developing SMN or CVD among survivors who developed cardiovascular disease as first event.

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  Figure 4. Different measures of the cumulative burden of subsequent malignancies and cardiovascular disease by treatment modality. For patients receiving no anthracyclines and no alkylating chemotherapy (except low-dose procarbazine), (A) the cumulative incidence of developing subsequent malignancy or cardiovascular disease as first event and (B) the mean cumulative count for all subsequent malignancies and cardiovascular diseases by radiotherapy field are shown. For patients receiving anthracycline-containing chemotherapy, (C) the cumulative incidence of developing subsequent malignancy or cardiovascular disease as first event and (D) the mean cumulative count for all subsequent malignancies and cardiovascular diseases by radiotherapy field are shown. Incomplete mantle field radiotherapy is only shown in the graphs for patients receiving anthracycline-containing chemotherapy because in the anthracycline era smaller radiotherapy fields were introduced.