Background: In Slovenia, a specialized late-effects follow-up clinic for childhood cancer survivors has been in operation for 40 years. During the past 20 years, we have also included survivors treated for lymphoma in young adulthood. Given the excellent cure rates of Hodgkin lymphoma and the long life expectancy of survivors, long-term follow-up is essential. Active surveillance for treatment-related late effects and their timely management can help reduce morbidity and improve quality of life among survivors. At our institution, we analyzed data on late effects among patients with Hodgkin lymphoma treated in Slovenia between 1983 and 2010.
Methods: The Cancer Registry of the Republic of Slovenia provided data on all patients diagnosed with and treated for Hodgkin lymphoma in Slovenia aged 18 to 30 years. Data on late effects were obtained from the medical records of the Late Effects Follow-up Clinic and subsequently analyzed statistically.
Results: We analyzed the data of 413 patients. At the time of data cut-off, 337 patients were alive, and 76 patients had died. In 46 patients, the cause of death was lymphoma, in 16 a second malignant disease, 4 died because of acute myocardial infarction, 1 had GVHD, and 10 died of other causes. Among patients in follow-up, 37.5% had at least one manifestation of cardiovascular disease. A total of 79 patients developed a second malignant neoplasm. The most common second malignancy was breast cancer (n = 13), followed by non-melanoma skin cancer (n = 12), thyroid cancer (n = 11), gynecological cancers (n = 11), hematologic malignancies (n = 5), lung cancer (n = 4), melanoma (n = 4), other lymphomas (n = 3), central nervous system tumors (n = 3), and head and neck cancers (n = 3). Two patients developed prostate cancer, while one patient each developed colorectal cancer, liver cancer, bladder cancer, and sarcoma. In survivors exposed to abdominal irradiation, colonoscopy has been advised and has been performed in 60% of eligible patients. Carcinoma was detected in one patient and lymphoma in another, while other findings included benign and premalignant lesions. Additional late effects evaluated included gonadal dysfunction, thyroid disease, metabolic syndrome, chronic kidney disease, chronic pulmonary disease, and psychological disorders.
Conclusion: Hodgkin lymphoma survivors face significant late morbidity. Risk-adapted lifelong follow-up is crucial for detecting and managing treatment-related complications.
Urska Rugelj, Lorna Zadravec Zaletel, Danijela Štrbac, Miha Toplak