Late effects after treatment of hodgkin lymphoma, a single centre experience

Introduction: Classical Hodgkin Lymphoma (cHL) has an incredibly high survival rate, exceeding 80% at 10 years. Continuous improvement in treatment strategies led to an increased number of survivors in the community. Most common complications encountered are secondary malignant neoplasms (SMN) and cardiovascular (CV) toxicity. Methods: We conducted a single-centre retrospective study including 157 patients diagnosed and treated for cHL between 1974 and 2016. Results: Median age at diagnosis in our cohort is 30 years old. Ninety-six patients (61%) had a stage 1 or 2 disease. Front line treatment consisted of radiotherapy alone for 3 patients (2%), chemotherapy alone for 74 patients (47%) and combined modalities for 80 patients (51%). Our median follow-up time is 11 years. We reported 96 cardiovascular events in 75 patients (48%). Median time to CV event was 10 years. Most of the events were graded 1 or 2 (71%) and were related to valvular heart disease. Grade 3 and 4 CV events (n = 21) were mainly due to coronary heart disease (43%) while most of the deaths related to CV toxicity were consequent to heart failure (57%). Twenty-seven patients (17%) were diagnosed with SMN, with a median time to SMN of 10 years. Most of them were solid malignancies (71%), including 6 lung cancers and 2 breast cancers (both BRCA2+). We encountered 2 secondary leukaemia, 3 myelodysplastic syndromes and 2 Non-Hodgkin Lymphoma. Overall survival rate in our cohort is 76% at 10 years. We observed 38 deaths, at a median age of 60 years old. Six patients (16%) died from cHL, and main causes of non-lymphoma deaths were secondary malignant neoplasms (10 pts, 28%) and cardiovascular events (7 pts, 18%). Discussion: Long-term complications in Hodgkin Lymphoma survivors are well-known and focus on how to decrease treatment related toxicity is constantly growing. Special attention is brought to the use of anthracyclines and mediastinal radiotherapy. Regarding CV toxicity, we tend to review our patients annually and to offer periodic screening with heart imaging. Our study showed that we detected CV events in almost half of our patients. Those events were mostly low-grade valvular disease not requiring treatment. However, more than 1 out of 4 CV event was graded 3 or more. The impact of the doses of anthracycline and/or radiotherapy received in our population still need to be determined. With a median time to CV event and to SMN of 10 years, we can confirm that long-term surveillance is recommended for the survivors. Conclusion: Cure is no longer enough when managing cHL. Our past and previous treatments led to an increasing number of survivors who are at higher risk of long-term complications. Recommendations for long-term surveillance programmes are emerging and are mostly experts-based opinions. More data are needed to identify high-risk patients and to provide them with an adequate monitoring. Keywords: Hodgkin lymphoma, late effects in lymphoma survivors, prevention and cancer interception No conflicts of interests pertinent to the abstract.