Adults who survived a minimum of 5 years after a prognosis of Hodgkin lymphoma had a standardized mortality ratio (SMR) of 1.96 (95% CI, 1.89-2.03) in contrast with the overall US inhabitants, in response to a population-based cohort research revealed in JAMA Community Open.
What did the population-based research present for lymphoma survivors?
Amongst 20,057 Hodgkin lymphoma survivors recognized throughout 16 Surveillance, Epidemiology, and Finish Outcomes (SEER) registries, there have been 2899 noticed deaths vs 1480.8 anticipated deaths, equivalent to an extra absolute threat (EAR) of 81.9 (95% CI, 75.8-88.0) per 10,000 patient-years. Relative mortality threat was elevated throughout all main causes of loss of life, pushed primarily by malignant circumstances, however the largest absolute variety of extra deaths was attributable to noncancer and cardiovascular causes quite than lymphoma recurrence itself.
With a median follow-up of 173 months (IQR, 120-226) after the 5-year survivorship index date, the cumulative all-cause mortality fee reached 8.0% (95% CI, 7.6%-8.4%) at 10 years and 15.0% (95% CI, 15.0%-16.0%) at 15 years. At 10 years, mortality from noncancer causes was highest at 2.5% (95% CI, 2.3%-2.8%), adopted by different neoplasms at 2.1% (95% CI, 1.9%-2.3%), cardiovascular circumstances at 1.6% (95% CI, 1.5%-1.8%), and Hodgkin lymphoma itself at 1.6% (95% CI, 1.5%-1.8%). Hodgkin lymphoma-related deaths plateaued over time, whereas mortality from different causes continued to rise.
Extra mortality diversified considerably throughout affected person and illness subgroups. Standardized mortality ratios exceeded 2.50 amongst Hispanic sufferers (SMR, 2.62; 95% CI, 2.37-2.89), non-Hispanic American Indian or Alaska Native sufferers (SMR, 3.31; 95% CI, 2.16-5.08), non-Hispanic Asian or Pacific Islander sufferers (SMR, 3.54; 95% CI, 2.91-4.29; P <.001), and sufferers recognized at ages 20 to 39 years (SMR, 2.52; 95% CI, 2.34-2.72; P <.001).
Nevertheless, the best EARs had been noticed amongst adults aged 60 to 89 years (EAR, 346.1; 95% CI, 299.7-392.5), non-Hispanic American Indian or Alaska Native sufferers (EAR, 210.4; 95% CI, 81.5-339.2), and people with combined cellularity Hodgkin lymphoma (EAR, 150; 95% CI, 126.3-173.7). Each SMR and EAR had been decrease amongst sufferers recognized in 2008 to 2017 than in 2000 to 2007 (SMR, 1.92 [95% CI, 1.79-2.06] vs 2.59 [95% CI, 2.4-2.79]; each P <.001), and mortality threat was larger amongst sufferers with stage III or IV illness than stage I or II illness (SMR, 2.27 [2.15-2.39] vs 1.72 [1.63-1.81]; P <.001).
Radiotherapy was related to decrease SMR and EAR total (SMR, 1.66 [95% CI, 1.55-1.77] vs 2.12 [95% CI, 2.03-2.22] with out radiotherapy; P <.001), however this affiliation held solely amongst sufferers with stage I or II illness (SMR, 1.52 [95% CI, 1.40-1.64] vs 1.94 [95% CI, 1.80-2.08]; P <.001). Amongst sufferers with stage III or IV illness, radiotherapy was not related to a big distinction in SMR (2.26 [95% CI, 1.95-2.59] vs 2.27 [95% CI, 2.14-2.40]; P = 0.95).
By particular explanation for loss of life, Hodgkin lymphoma carried by far the best relative threat (SMR, 638.65; 95% CI, 579.3-701.93) however contributed an EAR of 24.0 (95% CI, 21.7-26.3) per 10,000 patient-years, whereas heart problems (SMR, 1.63; 95% CI, 1.51-1.76; EAR, 15.0) and different noncancer causes (SMR, 1.42; 95% CI, 1.34-1.51; EAR, 17.9) contributed comparable or bigger absolute extra threat regardless of considerably decrease relative threat.
“The long-term predominance of noncancer and cardiovascular mortality helps built-in survivorship care past lymphoma recurrence surveillance. Our estimates quantify population-based disparities and extra mortality amongst adults recognized within the period of risk-adapted remedy, suggesting the necessity for continued enchancment in survivorship care,” Luis Malpica Castillo, MD, assistant professor within the Division of Lymphoma and Myeloma at The College of Texas MD Anderson Most cancers Heart, wrote within the publication with research coauthors.
How was the population-based research designed?
This was a retrospective, population-based cohort research utilizing SEER information linked to US inhabitants mortality charges. Eligible sufferers had been 20 years or older at prognosis with a primary major Hodgkin lymphoma recognized between 2000 and 2017, obtained chemotherapy with or with out radiotherapy, and survived a minimum of 5 years after prognosis, with follow-up out there by December 2023. The median age at prognosis was 36 years (IQR, 27-50); 53.7% of sufferers had been male, 15.0% had been Hispanic, 10.3% had been non-Hispanic Black, and 69.2% had been non-Hispanic White. A complete of 63.4% had nodular sclerosis subtype.
SMRs and EARs had been estimated utilizing anticipated deaths matched by age, intercourse, race and ethnicity, and calendar interval, assuming a Poisson distribution; cumulative incidence of mortality was estimated utilizing competing-risks strategies.
The research’s authors famous that prior stories in childhood Hodgkin lymphoma survivors have described larger SMRs, within the vary of 4 to eight, which can replicate variations in age at prognosis, remedy period, background comorbidity burden, and methodological variations in conditioning on 5-year survival. They acknowledged that SEER registries lack detailed scientific and socioeconomic information, limiting adjustment for potential confounders, and that associations with radiotherapy shouldn’t be interpreted as causal. Observe-up may additionally be inadequate to seize late radiation-associated outcomes, together with second major malignancies and heart problems, which frequently emerge many years after remedy.
Reference
Valcarcel B, Retamales J, Hildebrandt MA, et al. Mortality outcomes amongst long-term Hodgkin lymphoma survivors. JAMA Netw Open. 2026;9(8):e2629775. doi:10.1001/jamanetworkopen.2026.29775
