Long-term cause-specific mortality among 41,146 one-year survivors of Hodgkin lymphoma (HL)

Abstract

6511 Background: Despite high cure rates in HL, survival is compromised by deaths due to other causes. Long-term trends in cause-specific mortality are not well characterized. Methods: We identified 41,146 one-year HL survivors reported to 14 population-based cancer registries in North America and Europe (1943–2002), with 17,025, 5,899, and 1,273 patients followed for 10-, 20- and 30-years, respectively (total person-years: 374,031). Based on underlying cause of death and 8,270 deaths (excluding HL), we compared age-, gender- and calendar year-specific mortality rates to those in the general population of the 14 registries. Results: The overall relative risk (observed-to-expected ratio (O/E)) of mortality was 2.5 (95% CI 2.47–2.58; absolute excess risk (AER)=134 excess deaths/10,000 patients/year). Significant excess deaths were due to second cancers (SC) (O/E=4.1, AER= 63; O=3,107) and non-cancer (NC) causes (O/E=1.8, AER=49; O=4,202) and remained significantly elevated for more than 30 years following HL diagnosis. Significantly increased risks were observed for deaths due to cardiovascular (O/E=1.7), respiratory (O/E=2.4), infectious (O/E=8.6), and hematologic (O/E=8.2) diseases; risks were significantly elevated in both sexes, 4 age groups (<20, 20–39, 40–59, 60+ years), and 3 calendar year periods (<1970, 1970–84, 1985+). Significantly elevated risks due to SC and NC deaths (O/E=5.5 and 2.1, respectively) were highest in patients initially treated with radiation (RT) and chemotherapy (CT), but were also significantly elevated after RT alone (O/E=4.0 and 1.9) or CT alone (O/E=3.8 and 1.7). Risk of death from ischemic heart disease, pneumonia, bacterial infection, viral infection, and hematologic disorders was significantly elevated in all treatment groups. Comparable excesses of SC (AER=62) and NC (AER=62) deaths occurred in 30-year survivors, with all solid tumors (AER=54), cardiovascular disease (AER=44), and respiratory disease (AER=14) accounting for the greatest burden. Conclusions: HL patients demonstrate significant excesses of SC and NC deaths for more than 30 years after diagnosis and should be targeted for preventive measures in attempt to reduce excess mortality. No significant financial relationships to disclose.