Article, 2024

Long‐term cause‐specific mortality in adolescent and young adult Hodgkin lymphoma patients treated with contemporary regimens—A nationwide Danish cohort study

British Journal of Haematology, ISSN 1365-2141, 0007-1048, 10.1111/bjh.19586

Contributors

Rossetti, Sára 0000-0003-0508-5843 (Corresponding author) [1] Juul, Sidsel Jacobsen 0000-0002-2654-5194 [1] Eriksson, Frank [2] Warming, Peder Emil 0000-0003-0508-2503 [1] Glinge, Charlotte [1] El‐Galaly, Tarec Christoffer [3] [4] [5] Christensen, Jacob Haaber 0000-0002-9835-4522 [5] Kamper, Peter Martin Hjørnet [6] De Nully Brown, Peter [1] Gislason, Gunnar Hilmar 0000-0002-0548-402X [2] [7] Maraldo, Maja Vestmø 0000-0001-6159-5907 [1] Tfelt-Hansen, Jacob 0000-0003-3895-9316 [1] Hutchings, Martin 0000-0003-3873-1741 [1] [2]

Affiliations

  1. [1] Rigshospitalet
    2. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] University of Copenhagen
    3. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Aalborg University Hospital
    4. [NORA names: North Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];
  4. [4] Karolinska Institutet
    5. [NORA names: Sweden; Europe, EU; Nordic; OECD];
  5. [5] Odense University Hospital
    6. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];

Abstract

The documented treatment-induced excess mortality in Hodgkin lymphoma (HL) has spurred important treatment changes over recent decades. This study aimed to examine mortality among young HL patients treated with contemporary strategies, including historical data comparison. This nationwide study included 1348 HL patients, diagnosed in 1995-2015 and aged 15-40 at diagnosis. Among the patients, 66.5% had Ann Arbor stage I-II and 33.5% had stage III-IV disease. With a median follow-up of 14.76 years, 139 deaths occurred, yielding a 5-year overall survival of 94.6%. Older age, advanced disease, earlier treatment periods and extensive regimens were associated with higher overall mortality risk. The cumulative risk of HL-related death showed an initial sharp rise, with a plateau at 5.3% 10-year post-diagnosis. Deaths due to cardiovascular or pulmonary diseases and second cancers initially had minimal risk, gradually reaching 1.2% and 2.0% at the 20-year mark respectively. HL cases had a 7.5-fold higher mortality hazard than the background population. This study suggests that contemporary HL treatment still poses excess mortality risk, but recent changes have notably reduced overall and cause-specific mortality compared to earlier eras. Balancing treatment efficacy and toxicity remains crucial, but our findings highlight improved outcomes with modern treatment approaches.

Keywords

ANN, Ann Arbor stage I-II, Danish cohort study, HL cases, HL patients, HL treatment, Hodgkin, Hodgkin lymphoma, I-II, III-IV disease, advanced disease, age, approach, background, background population, balance treatment efficacy, cancer, cases, cause-specific mortality, changes, cohort study, comparison, contemporary strategies, cumulative risk, data comparison, death, decades, diagnosis, disease, efficacy, era, excess mortality, excess mortality risk, findings, follow-up, hazard, higher mortality hazard, higher overall mortality risk, initial sharp rise, long-term cause-specific mortality, lymphoma, marks, median follow-up, minimal risk, modern treatment approaches, mortality, mortality hazard, mortality risk, nationwide Danish cohort study, nationwide study, older age, outcomes, overall mortality risk, overall survival, patients, period, plateau, population, post-diagnosis, pulmonary disease, regimens, rise, risk, sharp rise, stage, stage I-II, stage III-IV disease, strategies, study, survival, toxicity, treatment, treatment approaches, treatment changes, treatment efficacy, treatment period, years

Funders

  • Copenhagen University Hospital

Data Provider: Digital Science

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