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State-of-the-art Issues in Hodgkin’s Lymphoma Survivorship

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Abstract

The prognosis of Hodgkin’s lymphoma (HL) has markedly improved as management strategies evolved. In the modern era, less than 15% of patients with early-stage, non-bulky HL will relapse, and less than one third of those with advanced disease will relapse. As therapy for HL intensified, and as disease-related outcomes improved, the impact of the late effects of therapy has become increasingly important. There is a growing body of literature describing the late morbidity experienced by survivors of HL, including risks of second primary malignancy, cardiac disease, pulmonary disease, and endocrine dysfunction. Additionally, the impact of disease and treatment on psychosocial function and quality of life has been a subject of investigation, with survivors often suffering from impairment. An understanding of these risks and the management implications inherent to them is central to the care of survivors of HL.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yahalom J, Mauch P: The involved field is back: issues in delineating the radiation field in Hodgkin’s disease. Ann Oncol 2002, 13(Suppl 1):79–83.

    PubMed  Google Scholar 

  2. Campbell B A, Voss N, Pickles T, et al.: Involved-nodal radiation therapy as a component of combination therapy for limited-stage Hodgkin’s lymphoma: a question of field size. J Clin Oncol 2008, 26:5170–5174.

    Article  PubMed  Google Scholar 

  3. van Rijswijk RE, Verbeek J, Haanen C, et al.: Major complications and causes of death in patients treated for Hodgkin’s disease. J Clin Oncol 1987, 5:1624–1633.

    PubMed  Google Scholar 

  4. Ng AK, Bernardo MP, Weller E, et al.: Long-term survival and competing causes of death in patients with early-stage Hodgkin’s Disease treated at age 50 or younger. J Clin Oncol 2002, 20:2101–2108.

    Article  PubMed  Google Scholar 

  5. Abrahamsen AF, Loge JH, Hannisdal E, et al.: Late medical sequelae after therapy for supradiaphragmatic Hodgkin’s disease. Acta Oncologica 1999, 38:511–515.

    Article  CAS  PubMed  Google Scholar 

  6. Ng AK, Bernardo MV, Weller E, et al.: Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. Blood 2002, 100:1989–1996.

    Article  CAS  PubMed  Google Scholar 

  7. Matasar MJ, Riedel ER, Ford JS, et al.: Late mortality and morbidity of patients with Hodgkin lymphoma treated in adulthood. J Clin Oncol 2009, 27(15s): abstr 8547.

    Google Scholar 

  8. Brierley JD, Rathmell AJ, Gospodarowicz MK, et al.: Late effects of treatment for early-stage Hodgkin’s disease. Br J Cancer 1998, 77:1300–1310.

    CAS  PubMed  Google Scholar 

  9. Matasar MJ, McCallen LN, et al.: Late mortality and morbidity of patients with Hodgkin lymphoma treated in adulthood. J Clin Oncol (Meeting Abstracts) 2009, 27(15S):8547.

    Google Scholar 

  10. Aleman BM, van den Belt-Dusebout AW, Klokman WJ, et al.: Long-term cause-specific mortality of patients treated for Hodgkin’s disease. J Clin Oncol 2003, 21:3431–3439.

    Article  PubMed  Google Scholar 

  11. Portlock CS, Boland P, Hays AP, et al.: Nemaline myopathy: a possible late complication of Hodgkin’s disease therapy. Hum Pathol 2003, 34:816–818.

    Article  PubMed  Google Scholar 

  12. van Leeuwen FE, Klokman WJ, Hagenbeek A, et al.: Second cancer risk following Hodgkin’s disease: a 20-year follow-up study. J Clin Oncol 1994, 12:312–325.

    PubMed  Google Scholar 

  13. • Hodgson DC, Gilbert ES, Dores GM, et al.: Long-term solid cancer risk among 5-year survivors of Hodgkin’s lymphoma. J Clin Oncol 2007, 25:1489–1497. This article, while not unique in subject, is extremely well performed, and gives detailed insight into the risks of, and risk factors for, second malignancy in survivors of HL.

    Article  PubMed  Google Scholar 

  14. Kaldor JM, Day NE, Clarke EA, et al.: Leukemia following Hodgkin’s disease. N Engl J Med 1990, 322:7–13.

    Article  CAS  PubMed  Google Scholar 

  15. van Leeuwen FE, Chorus AM, van den Belt-Dusebout AW, et al.: Leukemia risk following Hodgkin’s disease: relation to cumulative dose of alkylating agents, treatment with teniposide combinations, number of episodes of chemotherapy, and bone marrow damage. J Clin Oncol 1994, 12:1063–1073.

    PubMed  Google Scholar 

  16. Schonfeld SJ, Gilbert ES, Dores GM, et al.: Acute myeloid leukemia following Hodgkin lymphoma: a population-based study of 35,511 patients. J Natl Cancer Inst 2006, 98:215–218.

    Article  PubMed  Google Scholar 

  17. Diehl V, Franklin J, Pfreundschuh M, et al.: Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med 2003, 348:2386.

    Article  CAS  PubMed  Google Scholar 

  18. Aisenberg AC, Finkelstein DM, Doppke KP, et al.: High risk of breast carcinoma after irradiation of young women with Hodgkin’s disease. Cancer 1997, 79:1203–1210.

    Article  CAS  PubMed  Google Scholar 

  19. Ewing JC, White JM, Rattray A, et al.: Total registration of non-Hodgkin’s lymphoma and Hodgkin’s disease in Scotland: effect of deprivation and caseload on outcome. Hematology 2003, 8:211–220.

    Article  CAS  PubMed  Google Scholar 

  20. Salloum E, Doria R, Schubert W, et al.: Second solid tumors in patients with Hodgkin’s disease cured after radiation or chemotherapy plus adjuvant low-dose radiation. J Clin Oncol 1996, 14:2435–2443.

    CAS  PubMed  Google Scholar 

  21. Travis LB, Hill D, Dores GM, et al.: Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma. J Natl Cancer Inst 2005, 97:1428–1437.

    Article  PubMed  Google Scholar 

  22. Saslow D, Boetes C, Burke W, et al.: American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007, 57:75–89.

    Article  PubMed  Google Scholar 

  23. Zelenetz AD, Abramson JS, Advani RH, et al.: NCCN clinical practice guidelines in oncology: non-Hodgkin’s lymphomas. J Natl Compr Canc Netw 2010, 8:288–334.

    PubMed  Google Scholar 

  24. Das P, Ng AK, Earle CC, et al.: Computed tomography screening for lung cancer in Hodgkin’s lymphoma survivors: decision analysis and cost-effectiveness analysis. Ann Oncol 2006, 17:785–793.

    Article  CAS  PubMed  Google Scholar 

  25. • O’Brien MM, Donaldson SS, Balise RR, et al.: Second malignant neoplasms in survivors of pediatric Hodgkin’s lymphoma treated with low-dose radiation and chemotherapy. J Clin Oncol 2010, 28:1232–1239. O’Brien and colleagues offer new and compelling insight addressing the question of whether, as survivors treated with lower doses and smaller fields of radiation age, late complications of radiotherapy will continue to pose a risk. Unfortunately, in this pediatric series, lower doses of radiotherapy were not associated with decreased risk of second primary malignancy.

    Article  PubMed  Google Scholar 

  26. Adams MJ, Lipsitz SR, Colan SD, et al.: Cardiovascular status in long-term survivors of Hodgkin’s disease treated with chest radiotherapy. J Clin Oncol 2004, 22:3139–3148.

    Article  PubMed  Google Scholar 

  27. • Swerdlow AJ, Higgins CD, Smith P, et al.: Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 2007, 99:206–214. Paired with Aleman et al. [28•], compelling evidence that survivors of HL treated with mediastinal radiation therapy suffer from increased cardiovascular morbidity and mortality.

    Article  PubMed  Google Scholar 

  28. • Aleman BM, van den Belt-Dusebout AW, De Bruin ML, et al.: Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood 2007, 109:1878–1886. Paired with Swerdlow et al. [27•], compelling evidence that survivors of HL treated with mediastinal radiation therapy suffer from increased cardiovascular morbidity and mortality.

    Article  CAS  PubMed  Google Scholar 

  29. Reinders JG, Heijmen BJ, Olofsen-van Acht MJ, et al.: Ischemic heart disease after mantlefield irradiation for Hodgkin’s disease in long-term follow-up. Radiother Oncol 1999, 51:35–42.

    Article  CAS  PubMed  Google Scholar 

  30. Glanzmann C, Huguenin P, Lütolf UM, et al.: Cardiac lesions after mediastinal irradiation for Hodgkin’s disease. Radiother Oncol 1994, 30:43–54.

    Article  CAS  PubMed  Google Scholar 

  31. Lund MB, Ihlen H, Voss BM, et al.: Increased risk of heart valve regurgitation after mediastinal radiation for Hodgkin’s disease: an echocardiographic study. Heart 1996, 75:591–595.

    Article  CAS  PubMed  Google Scholar 

  32. Hodgson DC, Pintilie M, et al.: Clinically significant delayed cardiac morbidity following ABVD chemotherapy for Hodgkin lymphoma: A population-based study. J Clin Oncol (Meeting Abstracts) 2010, 28(15 Suppl):8059.

    Google Scholar 

  33. • De Bruin ML, Dorresteijn LD, van’t Veer MB, et al.: Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma. J Natl Cancer Inst 2009, 101:928–937. This is the first work of its kind, making use of powerful population-based data to establish the association between mediastinal or neck radiotherapy and cerebrovascular accident or stroke.

    Article  PubMed  Google Scholar 

  34. Carver JR, Shapiro CL, Ng A, et al.: American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 2007, 25:3991–4008.

    Article  CAS  PubMed  Google Scholar 

  35. •• Heidenreich PA, Schnittger I, Strauss HW, et al.: Screening for coronary artery disease after mediastinal irradiation for Hodgkin’s disease. J Clin Oncol 2007, 25:43–49. This is a seminal investigation into the feasibility and importance of screening for CAD in survivors of HL treated with mediastinal radiotherapy. Additional work is needed to advance the field and to generate evidence-based guidelines, but Heidenreich and colleagues have paved the way for this important work.

    Article  PubMed  Google Scholar 

  36. Kupeli S, Hazirolan T, et al.: Evaluation of coronary artery disease by computed tomography angiography in patients treated for childhood Hodgkin’s lymphoma. J Clin Oncol 2009, In press.

  37. Schuijf JD, Wijns W, Jukema JW, et al.: Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 2006, 48:2508–2514.

    Article  PubMed  Google Scholar 

  38. Martin WG, Ristow KM, Habermann TM, et al.: Bleomycin pulmonary toxicity has a negative impact on the outcome of patients with Hodgkin’s lymphoma. J Clin Oncol 2005, 23:7614–7620.

    Article  CAS  PubMed  Google Scholar 

  39. Knobel H, Havard Loge J, Brit Lund M, et al.: Late medical complications and fatigue in Hodgkin’s disease survivors. J Clin Oncol 2001, 19:3226–3233.

    CAS  PubMed  Google Scholar 

  40. Bethge W, Guggenberger D, Bamberg M, et al.: Thyroid toxicity of treatment for Hodgkin’s disease. Ann Hematol 2000, 79:114–118.

    Article  CAS  PubMed  Google Scholar 

  41. Bloom JR, Fobair P, Gritz E, et al.: Psychosocial outcomes of cancer: a comparative analysis of Hodgkin’s disease and testicular cancer. J Clin Oncol 1993, 11:979–988.

    CAS  PubMed  Google Scholar 

  42. Kornblith AB, Anderson J, Cella DF, et al.: Hodgkin disease survivors at increased risk for problems in psychosocial adaptation. Cancer 1992, 70:2214–2224.

    Article  CAS  PubMed  Google Scholar 

  43. Santoro A, Bonadonna G, Valagussa P, et al.: Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin’s disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol 1987, 5:27–37.

    CAS  PubMed  Google Scholar 

  44. Sieniawski M, Reineke T, Nogova L, et al.: Fertility in male patients with advanced Hodgkin lymphoma treated with BEACOPP: a report of the German Hodgkin Study Group (GHSG). Blood 2008, 111:71–76.

    Article  CAS  PubMed  Google Scholar 

  45. Jeruss JS, Woodruff TK: Preservation of fertility in patients with cancer. N Engl J Med 2009, 360:902–911.

    Article  CAS  PubMed  Google Scholar 

  46. West ER, Zelinski MB, Kondapalli LA, et al.: Preserving female fertility following cancer treatment: Current options and future possibilities. Pediatr Blood Cancer 2009, 53:289–295.

    Article  PubMed  Google Scholar 

  47. Blumenfeld Z, Eckman A: Preservation of fertility and ovarian function and minimization of chemotherapy-induced gonadotoxicity in young women by GnRH-a. J Natl Cancer Inst Monogr 2005, 34:40–43.

    Article  CAS  PubMed  Google Scholar 

  48. Beck-Fruchter R, Weiss A, Shalev E: GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data. Hum Reprod Update 2008, 14:553–561.

    Article  CAS  PubMed  Google Scholar 

  49. • Heutte N, Flechtner HH, Mounier N, et al.: Quality of life after successful treatment of early-stage Hodgkin’s lymphoma: 10-year follow-up of the EORTC-GELA H8 randomised controlled trial. Lancet Oncol 2009, 10:1160–1170. While many studies of QOL suffer from a number of methodological flaws, Heutte and colleagues’ reporting on long-term follow-up from the H8 trial applies scientific rigor to qualitative research, with important findings regarding the persistence of deficits in QOL across multiple domains.

    Article  PubMed  Google Scholar 

  50. Mols F, Vingerhoets AJ, Coebergh JW, et al.: Better quality of life among 10–15 year survivors of Hodgkin’s lymphoma compared to 5–9 year survivors: A population-based study. Eur J Cancer 2006, 42:2794–2801.

    Article  PubMed  Google Scholar 

  51. Loge JH, Abrahamsen AF, Ekeberg O, Kaasa S.: Reduced health-related quality of life among Hodgkin’s disease survivors: a comparative study with general population norms. Ann Oncol 1999, 10:71–77.

    Article  CAS  PubMed  Google Scholar 

  52. Wettergren L, Björkholm M, Axdorph U, Langius-Eklöf A: Determinants of health-related quality of life in long-term survivors of Hodgkin’s lymphoma. Qual Life Res 2004, 13:1369–1379.

    Article  CAS  PubMed  Google Scholar 

  53. Hjermstad MJ, Fosså SD, Oldervoll L, et al.: Fatigue in long-term Hodgkin’s disease survivors: a follow-up study. J Clin Oncol 2005, 23:6587–6595.

    Article  PubMed  Google Scholar 

  54. Ganz PA, Moinpour CM, Pauler DK, et al.: Health status and quality of life in patients with early-stage Hodgkin’s disease treated on Southwest Oncology Group Study 9133. J Clin Oncol 2003, 21:3512–3519.

    Article  PubMed  Google Scholar 

  55. Greil R, Holzner B, Kemmler G, et al.: Retrospective assessment of quality of life and treatment outcome in patients with Hodgkin’s disease from 1969 to 1994. Eur J Cancer 1999, 35:698–706.

    Article  CAS  PubMed  Google Scholar 

  56. Kornblith AB, Anderson J, Cella DF, et al.: Comparison of psychosocial adaptation and sexual function of survivors of advanced Hodgkin disease treated by MOPP, ABVD, or MOPP alternating with ABVD. Cancer 1992, 70:2508–2516.

    Article  CAS  PubMed  Google Scholar 

  57. Ford J, Schwartz SJ, et al.: Psychosocial functioning in survivors of Hodgkin lymphoma (HL) treated during adulthood. J Clin Oncol (Meeting Abstracts) 2008, 26(15 Suppl):9592.

    Google Scholar 

  58. Loge JH, Abrahamsen AF, Ekeberg O, et al.: Psychological distress after cancer cure: a survey of 459 Hodgkin’s disease survivors. Br J Cancer 1997, 76:791–796.

    CAS  PubMed  Google Scholar 

  59. Fobair P, Hoppe RT, Bloom J, et al.: Psychosocial problems among survivors of Hodgkin’s disease. J Clin Oncol 1986, 4:805–814.

    CAS  PubMed  Google Scholar 

  60. Cameron CL, Cella D, Herndon JE 2nd, et al.: Persistent symptoms among survivors of Hodgkin’s disease: an explanatory model based on classical conditioning. Health Psychol 2001, 20:71–75.

    Article  CAS  PubMed  Google Scholar 

  61. Mols F, Thong MS, Vreugdenhil G, et al.: Long-term cancer survivors experience work changes after diagnosis: results of a population-based study. Psychooncology 2009, 18:1252–1260.

    Article  PubMed  Google Scholar 

  62. Langeveld NE, Ubbink MC, Last BF, et al.: Educational achievement, employment and living situation in long-term young adult survivors of childhood cancer in the Netherlands. Psychooncology 2003, 12:213–225.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

    Shrujal S. Baxi & Matthew J. Matasar

  2. Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

    Matthew J. Matasar

  3. Hematology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

    Matthew J. Matasar

  4. Department of Medicine, Weill Medical College of Cornell University, New York, NY, 10065, USA

    Matthew J. Matasar

  5. 1275 York Avenue, New York, NY, 10065, USA

    Matthew J. Matasar

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  1. Shrujal S. Baxi
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Correspondence to Matthew J. Matasar.

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Baxi, S.S., Matasar, M.J. State-of-the-art Issues in Hodgkin’s Lymphoma Survivorship. Curr Oncol Rep 12, 366–373 (2010). https://doi.org/10.1007/s11912-010-0123-2

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