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© The Author 2007. Published by Oxford University Press.
ARTICLE |
Myocardial Infarction Mortality Risk After Treatment for Hodgkin Disease: A Collaborative British Cohort Study
Affiliations of authors: Sections of Epidemiology (AJS, CDH) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Yorkshire Cancer Research Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); Cancer Research UK Medical Oncology Unit, St Bartholomew's Hospital, London, UK (AL, ALSR); Cancer Research UK Department of Medical Oncology, Christie Hospital and The University of Manchester, Manchester, UK (JAR); Cancer Research UK and University College London Cancer Trials Centre (PS), and Department of Haematology (DCL), University College Hospital, London, UK
Correspondence to: Anthony J. Swerdlow, DSc, Section of Epidemiology, Sir Richard Doll Building, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK (e-mail: anthony.swerdlow{at}icr.ac.uk).
BACKGROUND: Myocardial infarction is a major cause of excess long-term mortality in survivors of Hodgkin disease, but limited information exists on the effects of specific chemotherapy regimens used to treat these patients on their risk of death from myocardial infarction.
METHODS: We followed a cohort of 7033 Hodgkin disease patients who were treated in Britain from November 1, 1967, through September 30, 2000, and compared their risk of myocardial infarction mortality with that in the general population of England and Wales. All statistical tests were two-sided.
RESULTS: A total of 166 deaths from myocardial infarction occurred in the cohort, statistically significantly more than expected (standardized mortality ratio [SMR] = 2.5, 95% confidence interval [CI] = 2.1 to 2.9), with an absolute excess risk of 125.8 per 100 000 person-years. Standardized mortality ratios decreased sharply with older age at first treatment, but absolute excess risks of death from myocardial infarction increased with older age up to age 65 years at first treatment. The statistically significantly increased risk of myocardial infarction mortality persisted through to 25 years after first treatment. Risks were increased statistically significantly and independently for patients who had been treated with supradiaphragmatic radiotherapy, anthracyclines, or vincristine. Risk was particularly high for patients treated with the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen (SMR = 9.5, 95% CI = 3.5 to 20.6). Risk at 20 or more years after first treatment was particularly great for patients who had received supradiaphragmatic radiotherapy and vincristine without anthracylines (SMR = 14.8, 95% CI = 4.8 to 34.5).
CONCLUSIONS: The risk of death from myocardial infarction after treatment for Hodgkin disease remains high for at least 25 years. The increased risks are related to supradiaphragmatic radiotherapy but may also be related to anthracycline and vincristine treatment.
| CONTEXT AND CAVEATS Prior knowledge Long-term survivors of Hodgkin disease have a higher risk of death from myocardial infarction than does the general population. However, the effects of specific chemotherapy regimens that are used to treat Hodgkin disease patients on their risk of death from myocardial infarction are unclear. Study design Collaborative British cohort study. Contribution The risk of death from myocardial infarction among Hodgkin disease patients was two and a half times that in the general population. Increased risks persisted for at least 25 years after treatment. The risk of myocardial infarction mortality was increased for Hodgkin disease patients who had been treated with supradiaphragmatic radiotherapy, anthracyclines, or vincristine. Limitations The analyses did not take into account potential differences in nontherapeutic risk factors for myocardial infarction between the cohort or specific treatment groups and the general population. The risks associated with specific chemotherapy agents could not be estimated with certainty because different agents are frequently used in combination. Implications Additional studies in other cohorts and/or case–control studies are needed to clarify the association between specific chemotherapeutic agents and regimens and myocardial infarction mortality.
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Editorial about this Article
- An Affair of the Heart
- John D. Boice, Jr
J Natl Cancer Inst 2007 99: 186-187.[Extract] [Full Text] [PDF]
Related Article in JNCI
- Press Release: Study Analyzes Heart Attack Mortality Risk Associated with Hodgkin Disease Treatments
- Andrea Widener
J Natl Cancer Inst 2007 99: 181.[Extract] [Full Text]
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