Impact of Risk-Adapted Therapy for Pediatric Hodgkin Lymphoma on Risk of Long-Term Morbidity: A Report From the Childhood Cancer Survivor Study
| Autor: | Sharon M. Castellino, Paul C. Nathan, Raymond J. Hutchinson, Wendy M. Leisenring, Kayla Stratton, Gregory T. Armstrong, Suzanne L. Wolden, Kevin C. Oeffinger, Susan A. Smith, Melissa M. Hudson, Dana Barnea, Charles A. Sklar, Leslie L. Robison, Louis S. Constine, Lisa Diller, Rebecca M. Howell, Tara O. Henderson |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Canada Cancer Research 2019-20 coronavirus outbreak Pediatrics medicine.medical_specialty Time Factors Adolescent Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) MEDLINE Childhood Cancer Survivor Study Risk Assessment Young Adult 03 medical and health sciences 0302 clinical medicine Cancer Survivors Risk Factors Cause of Death medicine Humans 030212 general & internal medicine Age of Onset Child Retrospective Studies business.industry Incidence Long term morbidity Incidence (epidemiology) Infant Newborn Infant Cancer ORIGINAL REPORTS Middle Aged medicine.disease Hodgkin Disease United States Treatment Outcome Oncology Child Preschool 030220 oncology & carcinogenesis Chronic Disease Hodgkin lymphoma Female business |
| Zdroj: | J Clin Oncol |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.20.01186 |
| Popis: | PURPOSE To determine the incidence of serious chronic health conditions among survivors of pediatric Hodgkin lymphoma (HL), compare by era of therapy and by selected cancer therapies, and provide estimates of risks associated with contemporary therapy. METHODS Assessing 2,996 5-year HL survivors in the Childhood Cancer Survivor Study diagnosed from 1970 to 1999, we examined the cumulative incidence of severe to fatal chronic conditions (grades 3-5) using self-report conditions, medically confirmed subsequent malignant neoplasms, and cause of death based on the National Death Index. We used multivariable regression models to estimate hazard ratios (HRs) per decade and by key treatment exposures. RESULTS HL survivors were of a mean age of 35.6 years (range, 12-58 years). The cumulative incidence of any grade 3-5 condition by 35 years of age was 31.4% (95% CI, 29.2 to 33.5). Females were twice as likely (HR, 2.1; 95% CI, 1.8 to 2.4) to have a grade 3-5 condition compared with males. From the 1970s to the 1990s, there was a 20% reduction (HR, 0.8; 95% CI, 0.7 to 0.9) in decade-specific risk of a grade 3-5 condition ( P trend = .002). In survivors who had a recurrence and/or hematopoietic cell transplant, the risk of a grade 3-5 condition was substantially elevated, similar to that of survivors treated with high-dose, extended-field radiotherapy (HR, 1.2; 95% CI, 0.9 to 1.5). Compared with survivors treated with chest radiotherapy ≥ 35 Gy in combination with an anthracycline or alkylator, a contemporary regimen for low-intermediate risk HL was estimated to lead to a 40% reduction in risk of a grade 3-5 condition (HR, 0.6; 95% CI, 0.4 to 0.8). CONCLUSION This study demonstrates that risk-adapted therapy for pediatric HL has resulted in a significant reduction in serious long-term outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|