Journal
BRITISH JOURNAL OF HAEMATOLOGY
Volume 172, Issue 5, Pages 757-768Publisher
WILEY
DOI: 10.1111/bjh.13903
Keywords
chemotherapy; hodgkin lymphoma; late effects; radiotherapy; teenage and young adult cancer
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Funding
- Canadian Cancer Society (CCS) Research Institute
- Canadian Cancer Society British Columbia and Yukon Division
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Late complications affecting Hodgkin lymphoma (HL) survivors are well described in paediatric and adult-based publications. This study determined the late morbidity and mortality risk for 442 teenage and young adult (TYAs) 5-year HL survivors, diagnosed at 15-24years of age between 1970 and 1999, identified from the British Columbia Cancer Registry. Treatment details were abstracted from charts. Survivors and a matched comparison cohort were linked to provincial administrative health datasets until December 2006 and regression analysis was performed, providing risk ratios regarding mortality, secondary malignancy and morbidity causing hospitalisation. Sixty (136%) survivors experienced late mortality with excess deaths from secondary cancer [standardised mortality ratio (SMR) 186; 95% confidence interval (CI) 11-294] and non-malignant disease (SMR 36; 95% CI 22-55). Excess secondary cancers (standardised incidence ratio 78; 95% CI 56-105) were associated with radiotherapy [Hazard ratio (HR) 27; 95% CI 1-77] and female gender (HR 18; 95% CI 1-34). Of 281 survivors treated between 1981 and 1999, 143 (51%) had morbidity resulting in hospitalisation (relative risk 145; 95% CI 122-173). Hospitalisation significantly increased with combined modality therapy, chemotherapy alone and recent treatment era. TYA HL survivors have excess risk of mortality and secondary malignancy continuing 30years from diagnosis. Radiotherapy is associated with secondary malignancy and current response-adapted protocols attempt to minimise exposure, but late morbidity causing hospitalisation remains significant.
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