High Prevalence of Chronic Health Conditions in Survivors of Hodgkin Lymphoma Treated during Adulthood.

Background: An increased risk of morbidity, including second primary malignancies and cardiovascular disease, has been reported in survivors of Hodgkin lymphoma (HL) diagnosed during adulthood. However, in contrast to our understanding of the late effects of treatment of children with HL, the global burden of chronic morbidity among long-term survivors of adult-onset HL is poorly characterized.

Methods: We conducted a survey-based cohort study of patients treated as adults with protocol-based first-line therapy for HL at our center from 1975 to 2000. The protocols included 6 combined modality trials (CMT) of chemotherapy (CT) + radiation therapy (RT), with the exception of a single CT-only arm in 1 trial. Chronic health conditions were assigned severity scores based on a modification of the Common Terminology Criteria for Adverse Events, version 3 (grades 1 through 4, ranging from mild to life-threatening or disabling).

Results: Of 707 patients for whom follow-up was available, 517 were alive. Median survival was 29 years. Survey data were available from 169 patients, with a median time from last treatment to interview date of 21 years. Of responders, median age at interview was 48 years (range, 25–88) and median age at treatment was 29 years (range, 16–66). Fifty percent were women, and 96% were white, non-Hispanic. Self-reported chronic health conditions were very common in our cohort: 94% of respondents reported any chronic health condition, and 60% described chronic health conditions that were grades 3 or 4 in severity (Table 1). Frequently reported conditions included cardiovascular, musculoskeletal, endocrine, and psychiatric disorders. Sixty percent of patients reported grade ≥1 cardiovascular dysfunction (20% ≥grade 3), 40% grade ≥1 musculoskeletal (7% ≥grade 3), 71% ≥grade 1 endocrine (17% ≥grade 3), and 23% ≥grade 1 psychiatric (21% ≥grade 3). Second primary malignancies were reported by 23%, and infectious conditions by 34%. Additional data collection on surviving and deceased patients is ongoing.

Conclusions: These results document the high prevalence of chronic illness among survivors of HL treated as adults. Evidence-based guidelines built upon such data are needed to aid clinicians in the management of the late morbidities associated with HL treatment.