Long-term cardiac morbidity in adolescent and young adult survivors of classical Hodgkin lymphoma: the British Columbia experience.

Adolescents and young adults (AYA) with classical Hodgkin lymphoma (cHL) have excellent survival outcomes. However, the late effects of treatment, including cardiovascular disease (CVD), can impact long-term disease-free morbidity and mortality. Using population-level administrative data, we evaluated rates of CVD in 2-year AYA survivors of cHL, aged 16-39 years, treated with ABVD or equivalent chemotherapy, with or without radiotherapy (RT). With a median follow up of 17 years (range 2.3-29 years), risk of CVD was 2.9-fold higher relative to controls, with a 5.2-fold risk of heart failure (HF) and 2.4-fold risk of ischemic heart disease (IHD). Risk of HF was associated with anthracycline-containing chemotherapy regimens alone or with combined modality therapy; whereas higher IHD risk was identified only in those treated with RT. At 20 years after the most recent cHL diagnosis or relapse, the cumulative incidence of HF was 4.3% in cases versus 0.8% in controls, and for IHD was 8.3% in cases versus 2.8% in controls. Treatment after 2005 using a PET scan guided approach reduced the overall use of RT (56.0% before 2005 vs. 14.9% 2005 and after), and was associated with a lower 15-year cumulative incidence of IHD (before 2005: 3.4% [95%CI: 1.8-5.1%]; 2005 and after: 0.7% [95%CI: 0-1.7%]) with the latter era comparable to controls; (1.6% [95%CI: 1.3-1.9%]). cHL survivors had increased 20-year cumulative mortality above that of age-matched controls (5.0% vs. 2.0%). These results can inform surveillance strategies, screening guidelines, and recommendations for risk factor modification for AYA cHL survivors.