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Blood, 1 March 2007, Vol. 109, No. 5, pp. 1878-1886. Prepublished online as a Blood First Edition Paper on November 21, 2006; DOI 10.1182/blood-2006-07-034405. This Article Full Text (PDF) All Versions of this Article: blood-2006-07-034405v1 109/5/1878    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Aleman, B. M.P. Articles by van Leeuwen, F. E. Search for Related Content PubMed PubMed Citation Articles by Aleman, B. M.P. Articles by van Leeuwen, F. E. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted July 12, 2006 Accepted October 4, 2006 Late cardiotoxicity after treatment for Hodgkin's lymphoma Berthe M.P. Aleman, Alexandra W. van den Belt-Dusebout, Marie L. De Bruin, Mars B. van 't Veer, Margreet H.A. Baaijens, Jan Paul de Boer, Augustinus A.M. Hart, Willem J. Klokman, Marianne A. Kuenen, Gabey M. Ouwens, Harry Bartelink, and Flora E. van Leeuwen* Dept of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, Netherlands Dept of Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands Dept of Hematology, Dr Daniel den Hoed Cancer Center, Rotterdam, Netherlands Dept of Radiotherapy, Dr Daniel den Hoed Cancer Center, Rotterdam, Netherlands Dept of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands * Corresponding author; email: f.v.leeuwen{at}nki.nl. We assessed cardiovascular disease (CVD)-incidence in 1,474 Hodgkin's lymphoma (HL) survivors younger than 41 years at treatment (1965-1995). Multivariable Cox regression and competing risks analyses were used to quantify treatment-effects on CVD-risk. After a median follow-up of 18.7 years, risks of myocardial infarction (MI) and congestive heart failure (CHF) were strongly increased compared to the general population [Standardized Incidence Ratios (SIRs)=3.6 and 4.9, respectively], resulting in 35.7 excess cases of MI and 25.6 excess cases of CHF per 10,000 patients/year. SIRs of all CVDs combined remained increased for 25 years and were more strongly elevated in younger patients. Mediastinal radiotherapy significantly increased the risks of MI, angina pectoris, CHF and valvular disorders (2- to 7-fold). Anthracyclines significantly added to the elevated risks of CHF and valvular disorders from mediastinal RT (Hazard Ratios (HRs): 2.81 and 2.10, respectively). The 25-year cumulative incidence of CHF after mediastinal radiotherapy and anthracyclines in competing risk analyses was 7.9%. In conclusion, risks of several CVDs are 3- to 5-fold increased in HL-survivors compared to the general population, even after prolonged follow-up, leading to increasing absolute excess risks over time. Anthracyclines further increase the elevated risks of CHF and valvular disorders from mediastinal radiotherapy. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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