Blood Journal
Leading the way in experimental and clinical research in hematology

A population-based study of cardiac morbidity among Hodgkin lymphoma patients with pre-existing heart disease

  1. Sten Myrehaug1,
  2. Melania Pintilie2,
  3. Lingsong Yun3,
  4. Michael Crump4,
  5. Richard W. Tsang1,
  6. Ralph M. Meyer5,
  7. Jonathan Sussman6,
  8. Eric Yu7, and
  9. David C. Hodgson8,*
  1. 1 Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada;
  2. 2 Division of Clinical Sciences and Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada;
  3. 3 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada;
  4. 4 Department of Medical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada;
  5. 5 National Cancer Institute of Canada Clinical Trials Group and the Cancer Research Institute, Queen's University, Kingston, ON, Canada;
  6. 6 Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada;
  7. 7 Division of Cardiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada;
  8. 8 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
  1. * Corresponding author; email: david.hodgson{at}rmp.uhn.on.ca

Abstract

The risk of cardiac hospitalization (CH) in Hodgkin lymphoma (HL) patients with pre-existing heart disease was evaluated. Patients with HL were identified from a population-based registry (N=3,964). Data were abstracted from records of a randomly selected subcohort (N=1,096). A population-based registry was used to identify CH. Factors associated with CH, and the incidence of CH following HL were estimated with competing risk models. Pre-existing heart disease was the strongest predictor of post-treatment CH (HR=3.98, P<0.001) and significantly modified (p = 0.01) the effect of treatment on the risk of CH. Among patients with pre-existing heart disease, treatment with mediastinal RT plus doxorubicin-based chemotherapy (MRT+D) was associated with a 10-year incidence of CH>20% higher than treatment with chemotherapy alone. There is a high risk of CH following MRT+D among patients with pre-existing heart disease; this is an important consideration when weighing treatment options, and in the follow-up of these patients.

  • Submitted January 20, 2010.
  • Accepted May 9, 2010.