Late mortality and morbidity of patients with Hodgkin lymphoma treated in adulthood.
Late mortality and morbidity of patients with Hodgkin lymphoma treated in adulthood.
复制标题
成年期接受治疗的霍奇金淋巴瘤患者的晚期死亡率和发病率。
DOI：
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发表时间：
2009
影响因子：
45.3
通讯作者：
D. Straus
中科院分区：
文献类型：
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作者：
M. Matasar;L. N. McCallen;E. Riedel;J. Ford;K. Oeffinger;D. Straus
8547背景：在儿童时期接受治疗的成年霍奇金淋巴瘤(HL)幸存者中，观察到晚期死亡率和发病率增加，但在成年后接受治疗的患者表现得较差。
方法
我们调查了1975-2000年间在本中心接受治疗的成人患者的晚期死亡率和发病率。研究人群包括接受连续6项联合模式治疗(CMT)一线试验中的一项的所有患者，其中一项试验包括仅接受化疗的ARM。死因分类死亡率由图表回顾和国家死亡指数确定。生存率采用Kaplan-Meier方法，死因死亡率采用竞争风险方法学。将自我报告调查分发给幸存的患者，以评估晚期发病率；发病率的严重程度根据已发表的不良事件通用术语标准的改编进行评分。
结果
746名患者符合评估条件。在调查时，227名患者(30.4%)已经死亡：107例死于HL，100例死于HL以外的原因，20例死于不明原因(表1)。队列的20年OS为71%。由HL引起的累积死亡风险在治疗后22年被HL以外的其他原因超过。在521名幸存者中，233人(44.7%)获得了调查数据，平均随访时间为21.6年。晚期发病率很常见：94%报告有任何发病率，48%报告至少一次严重(3/4级)晚期发病率，22%报告两次或两次以上严重晚期发病率。最常见的严重疾病包括第二原发癌(SPM)(17%)、心血管(CV)(18%)和神经系统(18%)疾病。
结论
在接受CMT试验的成人中，到治疗后22年，由于HL死亡的风险超过了由于其他原因造成的死亡风险。在成年期间接受治疗的HL幸存者经历了相当大的晚期发病率。这些发现强调了针对成人HL幸存者晚期发病率的预防和早期干预的重要性。[表：见正文]没有重大财务关系需要披露。
8547 Background: Increased late mortality and morbidity have been observed among adult survivors of Hodgkin lymphoma (HL) treated in childhood, but are less well characterized for patients treated in adulthood.
METHODS
We investigated the late mortality and morbidity of adult patients treated at our center from 1975 to 2000. The study population consisted of all patients treated on one of 6 consecutive first-line trials of combined modality therapy (CMT), one of which included a chemotherapy-only arm. Cause-specific mortality was determined by chart review and National Death Index. Survival was estimated using the method of Kaplan-Meier, and cause-specific mortality using competing risk methodology. Self-report surveys were distributed to surviving patients to assess the prevalence of late morbidity; severity of morbidity was scored based on a published adaptation of the Common Terminology Criteria for Adverse Events.
RESULTS
746 patients were eligible for assessment. At time of survey, 227 patients (30.4%) had died: 107 deaths from HL, 100 from causes other than HL, and 20 from unknown cause ( Table 1 ). 20-year OS for the cohort was 71%. Cumulative risk of death due to HL is surpassed by causes other than HL by 22 years post-treatment. Among the 521 survivors, survey data were available for 233 (44.7%), with a median follow-up of 21.6y. Late morbidity was common: 94% reported any morbidity, 48% reported at least one severe (grade 3/4) late morbidity and 22% reported two or more severe late morbidities. The most prevalent severe morbidities included second primary malignancy (SPM) (17%), cardiovascular (CV) (18%) and neurologic (18%) disease.
CONCLUSIONS
Among adults treated on trials of CMT, by 22y post-treatment the risk of death due to HL is surpassed by risk of death due to other causes. Survivors of HL treated during adulthood experience substantial late morbidity. These findings underscore the importance of efforts directed at prevention of and early intervention for late morbidity in adult survivors of HL. [Table: see text] No significant financial relationships to disclose.