Risk of Cardiovascular Disease in Patients With Classical Hodgkin Lymphoma: A Danish Nationwide Register-Based Cohort Study

Abstract

Risk of cardiovascular disease (CVD) in patients with classical Hodgkin lymphoma (cHL) undergoing contemporary treatment is unclear. cHL patients ≥ 18 years at diagnosis treated with doxorubicin-containing chemotherapy between 2000 and 2022 were matched 1:5 with comparators on birth year, sex, and Charlson Comorbidity Index at time of matching (score of 0 or ≥ 1). Cause-specific cumulative incidence of a composite of CVDs with corresponding 95% confidence intervals (CIs) were computed with death and lymphoma relapse as competing events (i.e., by censoring individuals at such occurrences) using the Aalen-Johansen estimator. A total of 1905 patients and 9525 comparators with a median follow-up of 10 years (interquartile range, [IQR]: 5.9–17.4). Median age was 39 years (IQR: 27–56), median cumulative doxorubicin dose was 250 mg/m2 (IQR: 200–300). The CVD cumulative incidences were 4.7% (95% CI: 3.6–5.7) for patients versus 2.6% (95% CI: 2.3–2.9) for comparators at 5 years, 8.9% (95% CI: 7.2–10.5) versus 5.5% (95% CI: 4.9–6.0) at 10 years, and 17.0% (95% CI: 14.1–19.9) versus 8.2% (95% CI: 7.4–9.0) at 15 years. CVD remains a substantial effect after contemporary treatment for cHL, suggesting that awareness of symptoms and a low threshold for referral to diagnostic examination are still important measures during survivorship.