Late Effects of Treatment for Hodgkin Lymphoma

2006 ◽  
Vol 4 (3) ◽  
pp. 249-257 ◽  
Author(s):  
Debra L. Friedman ◽  
Louis S. Constine
Keyword(s):  
Hodgkin Lymphoma ◽  
Late Effects ◽  
Alkylating Agents ◽  
Prevention Strategies ◽  
Primary And Secondary Prevention ◽  
Organ Function ◽  
Delayed Effects ◽  
Therapeutic Protocols ◽  
The Impact

With advances in multimodality therapy, survival from Hodgkin lymphoma (HL) now exceeds 80%, resulting in a large cohort of survivors who are at risk for adverse long-term sequelae of therapy. This risk is complicated by possible endogenous predispositions to developing late effects, which relate to the patient's underlying susceptibility to HL. Finally, the impact of HL on the host can compromise organ function. This article reviews the possible dominant late effects for survivors of HL and strategies for monitoring and screening. As therapy for HL has changed and evolved, so has the spectrum of late effects. Mortality from HL has decreased, whereas delayed effects of therapy have increased. Refinements in therapy to decrease toxicity have occurred in response to the success in curing HL. Thus, modifications in therapeutic protocols using a risk-adapted strategy have reduced the use of alkylating agents, anthracyclines, and radiotherapy, which are associated with adverse long-term sequelae. The most clinically evident sequelae are those involving the endocrine and cardiovascular systems, and the most morbid are hematologic and solid second malignancies. Primary and secondary prevention strategies can be developed as knowledge of delayed effects of therapy increases.

Primary and secondary prevention strategies to reduce the impact of lung cancer in women: where are we now and where are we going?

2020 ◽  
Vol 56 (5) ◽  
pp. 340
Author(s):  
Adrián González-Marrón ◽  
Juan Carlos Martín-Sánchez ◽  
Nuria Matilla-Santander ◽  
Àurea Cartanyà-Hueso ◽  
Jose M. Martínez-Sánchez ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Secondary Prevention ◽  
Prevention Strategies ◽  
Primary And Secondary Prevention ◽  
The Impact

scholarly journals Comparison of the impact of cancer between British and US long-term non-Hodgkin lymphoma survivors

2016 ◽  
Vol 25 (3) ◽  
pp. 739-748 ◽  
Author(s):  
Shah-Jalal Sarker ◽  
Sophia K. Smith ◽  
Kashfia Chowdhury ◽  
Patricia A. Ganz ◽  
Sheryl Zimmerman ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
The Impact ◽  
Lymphoma Survivors

Is Recovery of Gonadal function possible in Very Long-Term Adult Male Survivors of Hodgkin's Lymphoma?

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2065-2065
Author(s):  
Wendy van Dorp ◽  
Ivana van der Geest ◽  
Joop Laven ◽  
Wim C.J. Hop ◽  
Sebastian J.C.M.M. Neggers ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Hodgkin Lymphoma ◽  
Adult Male ◽  
Alkylating Agents ◽  
Childhood Cancer Survivors ◽  
Inhibin B ◽  
Gonadal Function ◽  
Discontinuation Of Treatment

Abstract Abstract 2065 Background: Significant improvements in childhood cancer survival rates over recent decades have increased the importance of long-term treatment effects. Gonadal toxicity is a major complication in survivors of childhood cancer, which can especially occur in Hodgkin Lymphoma survivors, since they have been treated with alkylating agents. Inhibin B levels reflect gonadal function in men, and therefore this marker can be used to identify subgroups of childhood cancer survivors at risk for impaired gonadal function. Hitherto in male childhood cancer survivors, follow-up studies of gonadal function are lacking. Objective: To evaluate possible recovery of gonadal dysfunction over time in adult male survivors. Methods: In this retrospective study, adult male long-term childhood cancer survivors (n=201) of whom 24 (12%) were survivors of Hodgkin lymphoma were included. Serum inhibin B levels were used as a surrogate marker for gonadal function. Results: Median age at diagnosis was 6.0 years (range 0.0–17.5) and discontinuation of treatment was reached at a median age of 8.3 years (range 0.0–20.8). Inhibin B levels were first measured after a median follow-up time of 15.7 years (range 3.0–37.0). Median interval between the first (T1) and second measurement (T2) was 3.3 years (range 0.7–11.3). Median inhibin B level was 127 ng/L (range 5–366) at T1 and 156 ng/L (range 10–507) at T2. Survivors with an inhibin B level at first assessment≥105 ng/L have 50% chance to reach normal inhibin B levels, while this probability of recovery is negligible when the first inhibin B level is below 60 ng/L. The latter group consists of survivors of Hodgkin lymphoma treated with alkylating agents and survivors with an AAD score≥3. Conclusions: Our results suggest that recovery of gonadal function is possible even long after discontinuation of treatment. However, this recovery does not seem to occur in survivors who already reached critically low inhibin B levels after discontinuation of treatment, such as in survivors of a Hodgkin lymphoma treated with alkylating agents. Disclosures: No relevant conflicts of interest to declare.

Parenthood in Long-Term Survivors After CHOEP Treatment for Aggressive Lymphoma Is Not Significantly Impaired in Comparison to the General Population. Results From the Mabthera International Trial (MInT) and the DSHNHL NHLB1 Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3649-3649
Author(s):  
Julia Meissner ◽  
Sascha Dietrich ◽  
Marita Ziepert ◽  
Evelyn Kuhnt ◽  
Tanja Rixecker ◽  
...  
Keyword(s):  
General Population ◽  
Hodgkin Lymphoma ◽  
Aggressive Lymphoma ◽  
Gnrh Analogue ◽  
International Trial ◽  
Female Patients ◽  
Male Patients ◽  
The Impact ◽  
Long Term Survivors

Abstract Abstract 3649 Background: A growing number of patients with aggressive lymphoma experience long term survival after front-line treatment and survivorship issues have been increasingly addressed in recent years. Within treatment-induced sequelae, gonadal failure represents a major late-effect of chemotherapy. With respect to hematologic malignancies the majority of data on fertility effects pertains to Hodgkin Lymphoma treatment regimens whereas information on gonadal toxicity of non-Hodgkin Lymphoma treatments is limited. While CHOP as the standard treatment for aggressive lymphoma is supposed to be associated with only temporary side-effects on fertility in both sexes, nothing is known about the fertility effect of a moderate intensification of CHOP by adding etoposide in frequently used regimens such as CHOEP or dose-adjusted EPOCH. Methods: Our study assessed fertility aspects in young patients with aggressive lymphoma who enjoy ongoing first remission after treatment in the Mabthera International Trial or the German DSHNHL NHLB1 study between 1995 and 2003. Long term survivors of both prospective studies were contacted and invited to answer a questionnaire. Patients who received radiotherapy to the gonadal area as part of their primary treatment as well as those who received chemotherapy for secondary neoplasia were excluded from the analysis. Data on parenthood obtained in the subgroup of patients who received 6 complete cycles (R)-CHOEP (total cyclophosphamide and etoposide dose 4,500 mg/m2 and 1,800 mg/m2, respectively) is reported here. Results: Altogether 66 (31 female, 35 male) patients agreed to participate in the survey. Median age at treatment was 32.5 years (range: 18 – 40) and at time of data collection 44 years (range: 28 – 55), respectively, with a median follow-up after treatment completion of 11 years (range: 7 – 17). While 31 (46.9%) patients already had children before treatment (18 female – 58.1%, 13 male – 37.1%), 35 (53.0%) expressed a clear desire for children after treatment (14 female – 45.2%, 21 male – 60.0%). Ten of these 35 patients did not try to achieve pregnancy, with lack of partner being the main reason. Of the remaining 25 patients (12 female, 13 male) who tried to achieve pregnancy, 18 (9 female – 75%, 9 male – 69%) were finally successful. Apart from 2 deliberate abortions all pregnancies were uncomplicated and resulted in 25 live births. No major health problems were reported in the children. The interval between completion of treatment and birth of first child after treatment ranged from 21 to 146 months (median 58 months) in female patients and from 25 months to 106 months (median 60.5 months) in male patients. Patients not achieving pregnancy tended to be older then patients who successfully achieved pregnancy (median age 30 versus 25 in female patients and 34.5 versus 28 years in male patients). Not achieving parenthood after treatment was associated with emotional stress in 3 of 3 female patients but only in 1 of 4 male patients. Fourteen patients chose cryopreservation of sperm before treatment but none of them utilized preserved sperm for reproductive purposes. Cryopreservation techniques were not used in female patients. Only one female patient received a GnRH analogue in parallel to chemotherapy and gave birth to two children after treatment. Comparison of the presented patient data with the German general population (The German Socio-Economic Panel, 2011) revealed only non-significant differences in the overall percentage of childless women (16.1% in the study population versus 26.0% in the general population, p=0.15) and men (45.7% versus 33.8%, p=0.07). Total fertility rate in female study patients (1.45) paralleled that in the general population (around 1.4 between 1980 and 2010). Conclusions: Parenthood after treatment with CHOP plus etoposide seems not to be significantly impaired in comparison to the general population. Most patients who had attempted post-treatment parenthood were successful. The small percentage of patients not achieving pregnancy despite a clear desire for parenthood after treatment is in line with previous reports on the fertility effects of CHOP. However, all patients of reproductive age should be offered counselling with regard to the impact of planned therapy on their fertility. Disclosures: No relevant conflicts of interest to declare.

Long-term impact of head and neck cancer (HNC) and treatment on financial distress and employment of HNC survivors.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21575-e21575
Author(s):  
Elizabeth Marie Wulff-Burchfield ◽  
David G Schlundt ◽  
Kemberlee Bonnet ◽  
Emily Castellanos ◽  
Mary S. Dietrich ◽  
...  
Keyword(s):  
Marital Status ◽  
Late Effects ◽  
Financial Distress ◽  
Locally Advanced ◽  
Financial Strain ◽  
Cognitive Changes ◽  
Financial Counseling ◽  
The Impact

e21575 Background: Increasing HNC survival highlights the importance of understanding late biopsychosocial outcomes. Financial and occupational impacts of HNC remain unexplored, thus we undertook a qualitative analysis to identify themes and explore the impact of HNC/treatment on survivors’ financial health. Methods: Eligibility: Locally-advanced HNC who participated in an R0-1, NED, and > 1 year post treatment. Ten of 12 eligible patients were interviewed. Topics queried: financial issues related to HNC/treatment, financial/insurance matters affecting treatment, impact of treatment on fiscal responsibilities, financial counseling, and late impact of HNC/treatment on work. Frequency distributions were used to summarize patient characteristics. Interviews were transcribed verbatim, double-coded, and organized into themes and subthemes. Results: 50% male, 100% Caucasian, 60% married, median age 64 years, and median time since treatment of 64 months. Most denied ongoing financial strain from HNC/treatment, citing mitigating factors of preparedness (e.g. preexisting savings), health/disability insurance, and marital status. Those with financial distress noted an income limited by savings or disability. None reported financially-related delays in care. However, 2 patients used free healthcare. Most denied impact of HNC/treatment on financial obligations, but a minority reported subsequent delays in dental care, paying credit card bills, and travel. Financial counseling was used by 4 patients; benefits included decreased stress, access to financial programs, and education. Healthcare providers were considered an important source of financial counseling. Not all patients returned to work; late effects (fatigue, cognitive changes) impaired work capacity for those who did. Limitations: Population may have been skewed by loss to follow-up of patients with financial toxicity that precluded ongoing medical follow-up. Conclusions: Long-term financial distress was limited in this cohort of HNC survivors. Preparedness, adequate insurance, marital status, and financial counseling attenuated financial impacts of HNC. For those returning to work, late effects may affect capacity.

scholarly journals Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

2015 ◽  
Vol 173 (2) ◽  
pp. 139-148 ◽  
Author(s):  
Judith Gebauer ◽  
Eva-Maria Fick ◽  
Annika Waldmann ◽  
Thorsten Langer ◽  
Ilonka Kreitschmann-Andermahr ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Hodgkin Lymphoma ◽  
Late Effects ◽  
Psychological Status ◽  
Endocrine Disorders ◽  
German Population ◽  
Thyroid Disorders ◽  
Northern Germany ◽  
Non Hodgkin Lymphoma ◽  
The Impact

ObjectiveDue to the increasing success and survival rates in the primary treatment of malignancies derived from the CNS as well as the hematopoietic system, endocrine late effects of cancer and its therapy are of growing importance. Despite evaluation of these late effects in patients treated for cancer in childhood, the impact on adults remains largely unclear.Methods1035 adult patients primarily diagnosed with a CNS malignancy, a Hodgkin (HL) or non-Hodgkin lymphoma (NHL) between 1998 and 2008 were recruited via the regional epidemiological cancer registry covering ∼2.8 million inhabitants in the federal state of Schleswig-Holstein, Northern Germany. The prevalence of endocrine disorders and current psychosocial impairment was assessed employing several questionnaires (SF-36v1, WHO-5).ResultsFully completed questionnaires of 558 patients were available for subsequent analysis showing markedly reduced overall performance and psychological status when compared to German reference data. Thyroid disorders were reported in 16.3% of patients with 10.4% suffering from hypo- and 5.9% from hyperthyroidism. Overall, 17.6% stated to be affected by diabetes mellitus with an increased rate of 21.1% among NHL patients and 11.5% of participants were affected by osteoporosis.ConclusionCompared to German population based studies on the prevalence of diabetes mellitus, osteoporosis and thyroid disorders the frequency of all these endocrine problems was significantly increased in CNS, HL, and NHL cancer survivors. These data confirm that not only children and adolescents but also adult cancer patients are at risk for therapy associated endocrine late effects.

scholarly journals The Impact of Radiation Field Size on Long-Term All-Cause Mortality of Stage I-II Hodgkin Lymphoma Patients

2017 ◽  
Vol 99 (2) ◽  
pp. S138-S139
Author(s):  
C. Patel ◽  
E. Michaelson ◽  
Y.H. Chen ◽  
B.J. Silver ◽  
K.J. Marcus ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Radiation Field ◽  
Stage I ◽  
Field Size ◽  
All Cause Mortality ◽  
The Impact

scholarly journals Quality of Life Among Long-Term Survivors of Non-Hodgkin Lymphoma: A Follow-Up Study

2013 ◽  
Vol 31 (2) ◽  
pp. 272-279 ◽  
Author(s):  
Sophia K. Smith ◽  
Deborah K. Mayer ◽  
Sheryl Zimmerman ◽  
Christianna S. Williams ◽  
Habtamu Benecha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Hodgkin Lymphoma ◽  
Symptom Burden ◽  
Non Hodgkin Lymphoma ◽  
The Impact ◽  
Long Term Survivors ◽  
Over Time

Purpose Little is known about change in quality of life (QOL) among long-term cancer survivors. We examined change over time in QOL among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical, and psychosocial risk factors for poor outcomes. Methods Surveys were mailed to 682 lymphoma survivors who participated in a study 5 years earlier, when on average they were 10.4 years postdiagnosis. Standardized measures of QOL, perceptions of the impact of cancer, symptoms, medical history, and demographic variables were reported at both time points and examined using linear regression modeling to identify predictors of QOL over time. Results A total of 566 individuals participated (83% response rate) who were a mean of 15.3 years postdiagnosis; 52% were women, and 87% were white. One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey. Participants who received only biologic systemic therapy reported improvement in physical health despite the passage of time. Older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer's impact were independent predictors of poor QOL. Lymphoma symptom burden, less social support, and having received a transplantation were related to negative perceptions of cancer's impact. Conclusion Moderate to severe symptom burden, limited social support, or having received a transplantation should alert the clinician to potential need for supportive services. Perceptions of cancer's impact are associated with QOL cross-sectionally and longitudinally; modifying these perceptions may thus provide a strategy for improving QOL.

scholarly journals OUTCOME AND TOXICITY PATTERNS IN CHILDREN AND ADOLESCENTS WITH NON-HODGKIN LYMPHOMA: A SINGLE INSTITUTION EXPERIENCE

2018 ◽  
Vol 10 (1) ◽  
pp. e2018020 ◽  
Author(s):  
Paola Angelini ◽  
Laura Rodriguez ◽  
Mohammed Zolaly ◽  
Ahmed Naqvi ◽  
Sheila Weitzman ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Hodgkin Lymphoma ◽  
Survival Rates ◽  
Age At Diagnosis ◽  
Single Institution ◽  
Non Hodgkin Lymphoma ◽  
Sick Children ◽  
The Impact

Background: The incidence and biology of non-Hodgkin lymphoma (NHL) vary according to age. Some data suggest that the impact of age in pediatric and adolescent NHL patients depends on the histological subtype. Objectives: We aimed to analyze the impact of age at diagnosis on clinical characteristics and treatment-related toxicity in children and adolescents with NHL.Methods: Retrospective review of medical records of children and adolescents diagnosed with NHL at the Hospital for Sick children, Toronto, between January 1995 and December 2008.Results: 164 children were diagnosed with NHL during the study period, with a median age at diagnosis of 10 years. With a median follow-up of 6.2 years, 5-year OS in patients aged <15 and 15-18 years was 89± 2% vs 82% ± 6%, respectively (P = 0.30), and 5-year EFS was 84% ± 3% vs. 77% ± 7%  (P= 0.37). In Burkitts lymphoma (BL) and lymphoblastic lymphoma (LL) there was a trend towards better outcomes in children compared to adolescents, with EFS of  91% ± 4% vs. 75% ± 15%, respectively in BL (P= 0.17),  and 82% ± 7% vs. 51.4% ± 2% respectively in LL (P= 0.16). Late effects occurred in 21 patients (12.8%).Conclusions: Children with NHL aged < 15 years tend to have better survival rates and less long-term toxicity than adolescents aged 15-18 years.

Sign in / Sign up

Export Citation Format

Share Document