Long-term cause-specific mortality of patients treated for Hodgkin's disease.
OBJECTIVE
To assess long-term cause-specific mortality of young Hodgkin's disease (HD) patients.


METHODS
The study population consisted of 1,261 patients treated for HD before age 41 between 1965 and 1987. Follow-up was complete until October 2000. For 95% of deaths, the cause was known. Long-term cause-specific mortality was compared with general population rates to assess relative risk (RR) and absolute excess risk (AER) of death.


RESULTS
After a median follow-up of 17.8 years, 534 patients had died (55% of HD). The RR of death from all causes other than HD was 6.8 times that of the general population, and still amounted to 5.1 after more than 30 years. RRs of death resulting from solid tumors (STs) and cardiovascular disease (CVD) were increased overall (RR = 6.6 and 6.3, respectively), but especially in patients treated before age 21 (RR = 14.8 and 13.6, respectively). When these patients grew older, this elevated mortality decreased. The overall AER of death from causes other than HD increased throughout follow-up. Patients receiving salvage chemotherapy had a significantly increased RR of death from STs, compared to patients receiving initial therapy only.


CONCLUSIONS
The main cause of death among HD patients was lymphoma, but after 20 years, HD mortality was negligible. The RRs and AERs of death from second primary cancers (SCs) and CVDs continued to increase after 10 years. Even more than 30 years after diagnosis, HD patients experienced elevated risk of death from all causes other than HD. Increased risk of death from SCs and CVDs was found especially in patients treated before age 21, but these risks seemed to abate with age.
Aleman
Berthe M P
BM
Department of Epidemiology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
van den Belt-Dusebout
Alexandra W
AW
Klokman
Willem J
WJ
Van't Veer
Mars B
MB
Bartelink
Harry
H
van Leeuwen
Flora E
FE
D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007239:Infections / Q000401:mortality; D007938:Leukemia / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000401:mortality; D016016:Proportional Hazards Models; D012306:Risk; D012307:Risk Factors; D015996:Survival Rate