Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study.
BACKGROUND
Myocardial infarction is a major cause of excess long-term mortality in survivors of Hodgkin disease, but limited information exists on the effects of specific chemotherapy regimens used to treat these patients on their risk of death from myocardial infarction.


METHODS
We followed a cohort of 7033 Hodgkin disease patients who were treated in Britain from November 1, 1967, through September 30, 2000, and compared their risk of myocardial infarction mortality with that in the general population of England and Wales. All statistical tests were two-sided.


RESULTS
A total of 166 deaths from myocardial infarction occurred in the cohort, statistically significantly more than expected (standardized mortality ratio [SMR] = 2.5, 95% confidence interval [CI] = 2.1 to 2.9), with an absolute excess risk of 125.8 per 100,000 person-years. Standardized mortality ratios decreased sharply with older age at first treatment, but absolute excess risks of death from myocardial infarction increased with older age up to age 65 years at first treatment. The statistically significantly increased risk of myocardial infarction mortality persisted through to 25 years after first treatment. Risks were increased statistically significantly and independently for patients who had been treated with supradiaphragmatic radiotherapy, anthracyclines, or vincristine. Risk was particularly high for patients treated with the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen (SMR = 9.5, 95% CI = 3.5 to 20.6). Risk at 20 or more years after first treatment was particularly great for patients who had received supradiaphragmatic radiotherapy and vincristine without anthracyclines (SMR = 14.8, 95% CI = 4.8 to 34.5).


CONCLUSIONS
The risk of death from myocardial infarction after treatment for Hodgkin disease remains high for at least 25 years. The increased risks are related to supradiaphragmatic radiotherapy but may also be related to anthracycline and vincristine treatment.
Swerdlow
Anthony J
AJ
Section of Epidemiology, Sir Richard Doll Building, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK. anthony.swerdlow@icr.ac.uk
Higgins
Craig D
CD
Smith
Paul
P
Cunningham
David
D
Hancock
Barry W
BW
Horwich
Alan
A
Hoskin
Peter J
PJ
Lister
Andrew
A
Radford
John A
JA
Rohatiner
Ama Z S
AZ
Linch
David C
DC
D000328:Adult; D000367:Age Factors; D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects* / Q000528:radiation effects*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality*; D011832:Radiation Injuries / Q000150:complications* / Q000209:etiology / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014750:Vincristine / Q000009:adverse effects
D018943:Anthracyclines; D014750:Vincristine