Cardiovascular and Thyroid Late Effects in Pediatric Patients with Hodgkin Lymphoma Treated with Abvd Protocol

Abstract

Background: Long-term Hodgkin Lymphoma (HL) survivors are at risk of developing a range of therapy-related complications that may present 10 -15 years after treatment. The goal of this study is to estimate the frequency of cardiovascular diseases and thyroid abnormalities in HL survivors and to determine the contributing risk factors. Methods: We performed a cross-sectional study on 208 HL survivors who were treated at the National Cancer Institute, Cairo University, or at the Children Cancer Hospital Egypt with ABVD chemotherapy ± radiotherapy with a minimum of five years follow up. Findings: The cumulative incidence of cardiac toxicity (CT) at five and nine years were 18·7% ± SD 2·7 and 43·3% ± SD 4·4, respectively. Preexisting cardiac abnormalities, cumulative anthracycline dose, and end of treatment cardiac status are strong predictors for late cardiotoxicity. Hypertension was observed in about 31% of HL survivors. Young age and obesity at the time of treatment are important factors for hypertension. Thyroid abnormalities developed with a 5-year cumulative incidence of 2%± SD 1 while at 9-years the cumulative incidence was 27·9%± SD 4·5. Thyroid dysfunction was observed in 21·2% and thyroid tumors in 1·6%. Subclinical hypothyroidism was the most common thyroid abnormality after HL treatment. Neck radiation therapy and the volume of thyroid gland exposed to radiation are important risk factors. Interpretation: Cardiotoxicity, hypertension, and thyroid dysfunction are frequent late effects following the ABVD regimen especially if combined with radiation therapy. Funding: None to declare. Declaration of Interest: The authors declare that there is no conflict of interest. Ethical Approval: The study was approved by the institutional review board of the NCI-Cairo University and the scientific medical advisory committee of CCHE.