Treatment of Hodgkin's lymphoma involves the use of chemotherapy and radiotherapy, both of which can reach the heart and cause cardiac problems including heart attacks. How does treatment for Hodgkin's lymphoma affect the risk of heart attacks later in life?
A study in the UK, published in January 2007, investigated the risk of heart attacks (medically termed 'myocardial infarctions') in those treated for Hodgkin lymphoma. More than 7000 patients with Hodgkin lymphoma were followed up for 23 years to determine how frequently anyone treated with Hodgkin disease would have heart attacks.
It seems that overall the risk of developing a heart attack is higher in those treated for Hodgkin lymphoma than in the general population.
This risk is especially high for those treated with any of the following:
- Radiation delivered to areas in the chest, axilla or neck.
- Chemotherapy with an Anthracycline based combination (that's a regimen containing doxorubicin or epirubicin, like ABVD).
- Chemotherapy with a Vincristine based regimen.
The risk increases with treatment received below 25 years of age, and keeps increasing till age 65. Above that, there's not much difference.
Chemotherapy and radiation are frequently life saving in those suffering from Hodgkin disease. Avoiding radiation and chemotherapy for this reason alone will be inappropriate. But as new research throws light on potential late toxicities, we must be prepared to deal with them by reducing the risk factors (like diet and smoking)that may further increase the chances of developing these complications. It also spurs the medical community to find new modalities for cure that will not affect our cardiac risk.