title: Cardiac Mortality in Children and Adolescents with Hodgkin's Lymphoma: A Surveillance, Epidemiology and End Results Analysis.
abstract: The purpose of this study was to evaluate the risk of cardiac death in pediatric Hodgkin's lymphoma (HL) survivors and identify high-risk groups that may need additional surveillance.
  
  
  
  The Surveillance, Epidemiology and End Results program database was queried to analyze the rates of radiation therapy (RT) use and cardiac-specific mortality (CSM) in HL patients, aged 0-21 years, treated from 1973 to 2007. Primary endpoint was cardiac mortality.
  
  
  
  A total of 6552 patients were included. Median follow-up was 12 years (range, 0-40). Median age at diagnosis was 17 years (range, 0-21). The majority were white (85.5%), from western states (41.2%), had nodular sclerosis HL (73.2%), presented with stage I or II disease (51.5%), and received RT (56.1%). Death from cardiac disease occurred in 114 patients (9.2% of all deaths). CSM for the entire cohort at 10-, 20-, and 30-year time points was 0.3%, 1.6%, and 5.0%, respectively. Median age at the time of cardiac death was 39 years (range, 18-58 years). Under multivariate analysis (MVA), adolescent patients (ages 13-21) had higher rates of CSM (hazard ratio [HR], 3.05; p = 0.005). Female gender (HR, 0.43; p < 0.001), patients treated from 1998 to 2007 (HR, 0.19; p = 0.018), and those with lymphocyte-rich histology (HR, 0.14; p = 0.047) had significantly lower rates of CSM. Use of RT was not associated with CSM under MVA (HR, 1.18, p = 0.452).
  
  
  
  The cumulative incidence of CSM in this population analysis of pediatric HL was 9.2%, with a steady decline over the past several decades. Adolescent patients at diagnosis and males were more likely to die of cardiac-related causes.
authors.affiliation: 1 Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: 1 Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, Colorado.|2 Department of Radiation Oncology, Oregon Health and Science University , Portland, Oregon.
authors.forename: Blair
authors.initials: B
authors.lastname: Murphy
authors.affiliation: 3 Department of Pediatrics, Division of Hematology and Oncology, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: Carrye R
authors.initials: CR
authors.lastname: Cost
authors.affiliation: 3 Department of Pediatrics, Division of Hematology and Oncology, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Garrington
authors.affiliation: 3 Department of Pediatrics, Division of Hematology and Oncology, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Greffe
authors.affiliation: 1 Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: Arthur K
authors.initials: AK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality*; D006689:Hodgkin Disease / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018426:SEER Program; D016019:Survival Analysis; D017741:Survivors; D055815:Young Adult
keywords: Hodgkin lymphoma; cardiotoxicity; pediatric; radiation therapy