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Originally published as JCO Early Release 10.1200/JCO.2003.07.131 on July 28 2003

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Journal of Clinical Oncology, Vol 21, Issue 18 (September), 2003: 3431-3439
© 2003 American Society for Clinical Oncology

Long-Term Cause-Specific Mortality of Patients Treated for Hodgkin’s Disease

Berthe M.P. Aleman, Alexandra W. van den Belt-Dusebout, Willem J. Klokman, Mars B. van’t Veer, Harry Bartelink, Flora E. van Leeuwen

From the Department of Radiotherapy, and the Department of Epidemiology, the Netherlands Cancer Institute, Amsterdam; and the Department of Hematology, the Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands.

Address reprint requests to Flora E. van Leeuwen, PhD, Department of Epidemiology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; e-mail: f.v.leeuwen{at}nki.nl.

Purpose: To assess long-term cause-specific mortality of young Hodgkin’s disease (HD) patients.

Patients and 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.

Conclusion: 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.

Supported by Dutch Cancer Society grant NKI 98-1833.


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