Background: Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular diseases (CVD) due to former treatment. In 2013, we started survivorship care for 5-year HL survivors at Dutch BETER clinics, where screening for CVD and associated risk factors according to uniform guidelines was implemented. Eligibility criteria for cardiovascular screening include: 1) age at HL treatment ≤60 and current age ≤70 years 2) treatment with mediastinal radiotherapy with/without anthracyclines (irrespective of dose) or anthracycline cumulative dose equivalent to doxorubicin ≥300 mg/m2. We assessed adherence to screening guidelines and the yield of previously undiagnosed (risk factors for) CVD in the screening program.
Methods: Data on patient and treatment characteristics and cardiovascular screening were collected retrospectively from medical records for 5-year HL survivors who visited the BETER outpatient clinic at three university medical centers in 2013-2020.
Results: We identified 240 patients, of whom 184 (76.7%) were eligible for cardiovascular screening (mean age at start follow-up 47.7 years). In eligible patients, CVD screening was performed according to the guidelines: physical examination (65.8%), lipids (86.4%), (NT)proBNP (82.1%), glucose (85.3%), electrocardiogram (97.3%) and echocardiography (96.7%). Screening yielded the following new diagnoses in eligible patients (Figure 1): hypertension (4.3%), dyslipidemia (10.3%), heart failure (1.1%), cardiomyopathy (1.6%), coronary artery disease (1.1%), conduction disorder/dysrhythmia (4.3%), pericarditis (0.5%), mild aortic or mitral valve insufficiency or stenosis (31.0%) and severe aortic or mitral valve insufficiency or stenosis (2.7%). Left ventricular ejection fraction (LVEF) was available for 87 eligible patients, of whom 9 (10.3%) had a LVEF <50%. Echocardiography was also performed in 32 out of 56 (57.1%) non-eligible patients: 21.9% had a new mild valve dysfunction, 3.1% had a new severe valve dysfunction.
Conclusion: Adherence to the screening guidelines was reasonable. A substantial number of new (risk factors for) cardiovascular conditions were diagnosed in the Dutch BETER screening program for HL survivors, also in non-eligible survivors. Future studies are needed to confirm findings in a broader population and to determine whether screening is effective in reducing burden of disease associated with late cardiovascular effects and in improving survivor’s quality of life.
Eline M.J. Lammers, Annelies Nijdam, Josée M. Zijlstra, Cécile P.M. Janus, Roel J. de Weijer, Flora E. van Leeuwen, Berthe M. P. Aleman, on behalf of the BETER consortium