Surveillance, early interventions, and treatment refinements may reduce mortality risks among high-risk subgroups in patients with classical Hodgkin lymphoma (cHL), according to a study published in the Journal of Clinical Oncology (2020;JCO2000264. doi:10.1200/JCO.20.00264).
“Despite evolving cHL treatment approaches, patients continue to face increased nonlymphoma mortality risks from multiple, potentially preventable causes,” wrote the study authors.
A population-based cohort of patients with cHL was identified from US-based cancer registries. The 20,007 individuals identified were diagnosed with early or advanced stage cHL and between the ages of 20 and 74 years. Patients were initially treated with chemotherapy between 2000-2016.
The study authors used standardized mortality ratios (SMRs) to compare cause-specific relative mortality risk following cHL to that expected in the general population. Excess absolute risks (EARs; per 10,000 patient-years) were estimated to quantify disease-specific death burden.
A total of 3380 deaths were identified in the cHL cohort with 39% being causes other than lymphoma.
Compared to the general US population, noncancer SMRs were increased 2.4-fold (95% CI, 2.2-2.6; observed, 559; EAR, 61.6) and 1.6-fold (95% CI, 1.4-1.7; observed, 473; EAR, 18.2) for advanced- and early-stage cHL, respectively.
Among the highest EARs for noncancer causes of death were those for heart disease (EAR, 15.1; SMR, 2.1), infections (EAR, 10.6; SMR, 3.9), interstitial lung disease (ILD; EAR, 9.7; SMR, 22.1), and adverse events (AEs) related to medications/drugs (EAR, 7.4; SMR, 5.0) after advanced-stage cHL and heart disease (EAR, 6.6; SMR, 1.7), ILD (EAR, 3.7; SMR, 13.1), and infections (EAR, 3.1; SMR, 2.2) after early-stage cHL.
SMRs for ILD, infections, and AEs were elevated less than 1 year after cHL. Deaths as a result of heart disease, ILD, infections, AEs, and solid tumors were highest in individuals age 60-74 years with advanced-stage cHL. —Lisa Kuhns
