BOF: Malignant (Hodgkin Lymphoma)

Which of the following conditions contributes most to the excess mortality seen in survivors of initial treatment for Hodgkin lymphoma within the first TEN years of initial diagnosis?

a) Acute leukaemia

b) Cardiovascular disease

c) Gastrointestinal malignancy

d) Infection

e) Relapsed Hodgkin Lymphoma

Answer:

e) Relapsed Hodgkin Lymphoma

Explanation:

Long survivors of Hodgkin lymphoma represent the majority of patients treated (70-80%) but survival remains impaired compared to the general population predominantly due to late side effects of chemotherapy and radiotherapy. Prior to 15 years, relapse of Hodgkin Lymphoma contributes the greatest risk. After this time, solid and haematological malignancy and cardiovascular disease represent the greatest causes of excess mortality. Gastrointestinal and respiratory tract malignancy and cardiovascular disease are the greatest risks.

As the treatments have evolved, radiotherapy used more selectively, at lower doses and in a more targeted manner, and as chemotherapy combinations have intensified in some cases (e.g. BEACOPP and increased use of salvage autologous and allogeneic stem cell transplant) and deintensified or been supplanted with new agents in others (such as AVD deintensification, and the use of brentuximab vedotin), the late effects landscape must be expected to change over time, but the legacy of older regimes is still seen.

Reference:

Hodgson DC, Gilbert ES, Dores GM, et al. Long-term solid cancer risk among 5-year survivors of Hodgkin's lymphoma. J Clin Oncol 2007; 25:1489.