Although adolescents and young adults (AYAs) who have survived classical Hodgkin lymphoma (cHL) often have substantial treatment-related morbidity that can lead to premature death, Ana Xavier, MD, and colleagues, in the Department of Pediatrics, Division of Hematology/Oncology at the University of Alabama at Birmingham, questioned whether recent changes in treatment have reduced excess mortality among long-term survivors of AYA-cHL. They presented their research on Monday, December 5, at the 58th American Society of Hematology Annual Meeting and Exposition in San Diego, CA.
The study authors collected data from more than 6,480 cases of 10-year survivors of cHL from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program to determine the excess mortality rate. Patients were aged 15–39 years and diagnosed with cHL as first malignant neoplasm from 1993–2003; follow-up was updated at the end of 2013. Researchers compared the observed mortality of patients with expected mortality of individuals matched by age, gender, and race from the general population to calculate the excess mortality rate.
Patients had a median age of 27 at time of diagnosis; most were non-Hispanic Caucasian (73.8%), were female (51.1%), and had stage I or stage II cHL (68%).
Researchers found that the excess mortality rate for AYA-cHL has improved over time. For 10-year AYA-cHL survivors with a diagnosis between 1993 and 2003, the rate was significantly better when compared to a similar patient group of 5,870 survivors with diagnosis between 1973 and 1992. The excess mortality rate at 15 and 18 years post-diagnosis was lower for survivors of stages I–II cHL than for survivors of stages III–IV. The most common causes of death, which were similar between all stages, were second malignancy (27.2%), cardiovascular disease (19%), and Hodgkin lymphoma (18.5%).
“Excess mortality rates for 10-year survivors of AYA-cHL has decreased with adoption of less toxic therapies,” the study authors said. Even so, mortality rates remain high for several years for long-term survivors because of cardiovascular disease and secondary malignancies. “Less-toxic therapies, control of cardiovascular diseases, and implementation of cancer prevention programs for survivors of AYA-cHL are needed,” they said.