Survivors of childhood Hodgkin's lymphoma at higher risk of future health problems

Jun 2 2008

Adults who survived childhood Hodgkin's Lymphoma should be especially vigilant about cancer and cardiovascular screenings, according to researchers from Wake Forest University Baptist Medical Center and colleagues.

Reporting at the annual meeting of the American Society of Clinical Oncology in Chicago today, Sharon Castellino, M.D., a pediatric oncologist, said a 26-center study of 1,927 Hodgkin's survivors found that treatments for the disease are associated with increased risk of dying from a second cancer or cardiovascular disease.

"The bottom-line message is that a portion of those who survive Hodgkin's Lymphoma continue to have significant health needs beyond their five-year 'cure' mark," said Castellino, an assistant professor of pediatrics at Brenner Children's Hospital, part of Wake Forest Baptist. "Survivors and their doctors need to be aware of continued risks in adulthood from treatment received more than 20 years ago."

Hodgkin's Lymphoma is a growth of malignant cells in the lymph system, which is part of the immune system. The disease is one of the more curable cancers and "was one of the first successes in the 1970s," said Castellino. Currently, Hodgkin's Lymphoma has a 5-year survival rate of 90 percent.

The disease most commonly occurs in the chest and its treatment involves radiation therapy of the neck and upper chest and/or chemotherapy. The goal of the study was to look at factors that may increase the risk of premature death. It involved 1,927 adults who were diagnosed between 1970 and 1986 at a median age of 14 years. They were followed for a median of 23 years through the Childhood Cancer Survivor Study (CCSS).

There have been 320 deaths in the group with 30 percent due to recurrence, 26 percent to a second cancer and 19 percent to a cardiovascular event such as a heart attack or stroke.

Among males, increased risk of premature death was associated with higher doses of chemotherapy regimens that included anthracycline drugs. In female five-year survivors, all doses of radiation therapy were associated with a higher risk of premature death.

The development of second malignancies impacted survival in both sexes. In addition, a cardiovascular condition conferred a significant risk of death in male survivors.

"It hadn't been clarified until this study that there was a different pattern of risks in men and women," said Castellino. "Other than a recurrence of the original cancer, the leading cause of death in women is breast cancer and for men it is cardiovascular events."

Castellino said the findings about cardiovascular disease are especially disturbing because about 30 percent of study participants had smoked at some time. She said the findings could lead to prevention recommendations, such as earlier health screenings.

"Currently, women who received treatment for the disease are advised to have mammograms as early as 25-years-old," she said. "But, currently there are no specific guidelines for heart disease prevention over those for the general population."

Since the 1980s, radiation therapy doses have been lowered in children with the goal of successfully treating the disease without causing undue side effects from the treatment. However, Castellino said that even though radiation doses are lower and techniques are refined, the heart and other critical structures are often exposed to radiation.

Castellino is continuing the research by working to learn more about what changes occur as a result of radiation and identifying ways to intervene - possibly with drugs - before the damage is done.

The CCSS was funded by the National Cancer Institute.

Co-researchers were Janet Tooze, Ph.D., and Ann Geiger, Ph.D., both with Wake Forest, and Wendy Leisenring, Sc.D., Pamela Goodman, M.S., Ann Mertens, Ph.D., Marilyn Stovall, Ph.D., Les Robison, Ph.D., and Melissa Hudson, M.D., all with St. Jude Children's Hospital.