Table 2 Treatment-related risk factors for developing either subsequent malignancy and cardiovascular disease (as combined event) and for developing both subsequent malignancy and cardiovascular disease

From: High burden of subsequent malignant neoplasms and cardiovascular disease in long-term Hodgkin lymphoma survivors

 

SMN or CVD ( n =2851)

SMN and CVD ( n =2851)

 

n/N

HR (95% CI)

n/N

HR (95% CI)

Radiotherapy a

No or limited radiation exposure

82/348

1.0 (Ref.)

7/348

1.0 (Ref.)

Inverted-Y

43/133

1.2 (0.8–1.7)

6/133

1.9 (0.6–5.6)

Incomplete mantle field

131/470

1.9 (1.4–2.5)

22/470

4.1 (1.7–9.7)

Mantle field

383/713

2.6 (2.1–3.4)

83/713

5.9 (2.7–13.0)

Incomplete subtotal nodal

92/237

2.6 (2.0–3.6)

15/237

6.1 (2.5–15.0)

Subtotal nodal

409/747

3.0 (2.3–3.8)

105/950

6.4 (2.9–14.0)

Total nodal

96/203

2.7 (2.0–3.7)

  

Chemotherapy regimen b

No chemotherapy/low-dose procarbazine/other

651/1147

1.0 (Ref.)

154/1147

1.0 (Ref.)

Anthracyclines

324/1129

1.3 (1.1–1.5)

36/1129

1.1 (0.7–1.6)

High-dose procarbazine

261/575

0.9 (0.8–1.1)

48/575

1.0 (0.7–1.3)

Smoking

Never

458/1266

1.0 (Ref.)

80/1266

1.0 (Ref.)

Ever

741/1408

1.4 (1.2–1.6)

156/1408

1.6 (1.2–2.1)

Unknown

37/177

0.9 (0.6–1.2)

2/177

0.4 (0.1–1.8)

  1. Abbreviations: CI=confidence interval; CVD=cardiovascular disease; HR=hazard ratio; n/N=number of events/number of patients in category; Ref.=reference; SMN=subsequent malignant neoplasm.
  2. Model was adjusted for sex and age at Hodgkin lymphoma (HL) diagnosis, and including an interaction term of time and age at HL diagnosis.
  3. aLimited radiation fields were defined as supraclavicular field, infraclavicular field, cervical field, inguinal field, or iliac field only. Incomplete mantle field was defined as irradiation above the diaphragm including the mediastinum or the axilla. Incomplete subtotal nodal included the combination of incomplete mantle field with radiation fields below the diaphragm or the combination of mantle field with an inguinal and/or iliac field. To assess the risk of developing both subsequent malignancy and cardiovascular disease, radiotherapy categories subtotal nodal and total nodal were combined to increase power. Patients for whom the field of radiotherapy was unknown were omitted from the analysis.
  4. bLow-dose procarbazine was defined as ⩽4.2 g m−2 procabazine dose, corresponding to three cycles of a hybrid regimen of mechloretamine, vincristine, procarbazine, and prednisone (MOPP). Other chemotherapy included various non-alkylating (single) agents, including mainly vinblastine. Patients receiving anthracycline-containing chemotherapy were categorised in the anthracyclines group, irrespective of procarbazine dose. The high-dose procarbazine group excluded patients receiving anthracyclines and was defined as a procarbazine dose of >4.2 g m−2 procarbazine, corresponding to more than three cycles of MOPP or more than six cycles of MOPP-ABV.
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