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dc.contributor.authorSwerdlow, Anthony J
dc.contributor.authorHiggins, Craig D
dc.contributor.authorSmith, P
dc.contributor.authorCunningham, David
dc.contributor.authorHancock, Barry W
dc.contributor.authorHorwich, Alan
dc.contributor.authorHoskin, Peter J
dc.contributor.authorLister, T Andrew
dc.contributor.authorRadford, John A
dc.contributor.authorRohatiner, Ama
dc.contributor.authorLinch, David C
dc.date.accessioned2009-06-12T10:14:42Z
dc.date.available2009-06-12T10:14:42Z
dc.date.issued2007-02-07
dc.identifier.citationMyocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. 2007, 99 (3):206-14 J. Natl. Cancer Inst.en
dc.identifier.issn1460-2105
dc.identifier.pmid17284715
dc.identifier.doi10.1093/jnci/djk029
dc.identifier.urihttp://hdl.handle.net/10541/70294
dc.description.abstractBACKGROUND: Myocardial infarction is a major cause of excess long-term mortality in survivors of Hodgkin disease, but limited information exists on the effects of specific chemotherapy regimens used to treat these patients on their risk of death from myocardial infarction. METHODS: We followed a cohort of 7033 Hodgkin disease patients who were treated in Britain from November 1, 1967, through September 30, 2000, and compared their risk of myocardial infarction mortality with that in the general population of England and Wales. All statistical tests were two-sided. RESULTS: A total of 166 deaths from myocardial infarction occurred in the cohort, statistically significantly more than expected (standardized mortality ratio [SMR] = 2.5, 95% confidence interval [CI] = 2.1 to 2.9), with an absolute excess risk of 125.8 per 100,000 person-years. Standardized mortality ratios decreased sharply with older age at first treatment, but absolute excess risks of death from myocardial infarction increased with older age up to age 65 years at first treatment. The statistically significantly increased risk of myocardial infarction mortality persisted through to 25 years after first treatment. Risks were increased statistically significantly and independently for patients who had been treated with supradiaphragmatic radiotherapy, anthracyclines, or vincristine. Risk was particularly high for patients treated with the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen (SMR = 9.5, 95% CI = 3.5 to 20.6). Risk at 20 or more years after first treatment was particularly great for patients who had received supradiaphragmatic radiotherapy and vincristine without anthracyclines (SMR = 14.8, 95% CI = 4.8 to 34.5). CONCLUSIONS: The risk of death from myocardial infarction after treatment for Hodgkin disease remains high for at least 25 years. The increased risks are related to supradiaphragmatic radiotherapy but may also be related to anthracycline and vincristine treatment.
dc.language.isoenen
dc.subject.meshAdult
dc.subject.meshAge Factors
dc.subject.meshAged
dc.subject.meshAnthracyclines
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols
dc.subject.meshChemotherapy, Adjuvant
dc.subject.meshCohort Studies
dc.subject.meshFemale
dc.subject.meshFollow-Up Studies
dc.subject.meshGreat Britain
dc.subject.meshHeart
dc.subject.meshHodgkin Disease
dc.subject.meshHumans
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshMyocardial Infarction
dc.subject.meshRadiation Injuries
dc.subject.meshRadiotherapy, Adjuvant
dc.subject.meshRegistries
dc.subject.meshResearch Design
dc.subject.meshRisk Assessment
dc.subject.meshRisk Factors
dc.subject.meshTime Factors
dc.subject.meshVincristine
dc.titleMyocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort studyen
dc.typeArticleen
dc.contributor.departmentSection of Epidemiology, Sir Richard Doll Building, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK. anthony.swerdlow@icr.ac.uken
dc.identifier.journalJournal of the National Cancer Instituteen
html.description.abstractBACKGROUND: Myocardial infarction is a major cause of excess long-term mortality in survivors of Hodgkin disease, but limited information exists on the effects of specific chemotherapy regimens used to treat these patients on their risk of death from myocardial infarction. METHODS: We followed a cohort of 7033 Hodgkin disease patients who were treated in Britain from November 1, 1967, through September 30, 2000, and compared their risk of myocardial infarction mortality with that in the general population of England and Wales. All statistical tests were two-sided. RESULTS: A total of 166 deaths from myocardial infarction occurred in the cohort, statistically significantly more than expected (standardized mortality ratio [SMR] = 2.5, 95% confidence interval [CI] = 2.1 to 2.9), with an absolute excess risk of 125.8 per 100,000 person-years. Standardized mortality ratios decreased sharply with older age at first treatment, but absolute excess risks of death from myocardial infarction increased with older age up to age 65 years at first treatment. The statistically significantly increased risk of myocardial infarction mortality persisted through to 25 years after first treatment. Risks were increased statistically significantly and independently for patients who had been treated with supradiaphragmatic radiotherapy, anthracyclines, or vincristine. Risk was particularly high for patients treated with the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen (SMR = 9.5, 95% CI = 3.5 to 20.6). Risk at 20 or more years after first treatment was particularly great for patients who had received supradiaphragmatic radiotherapy and vincristine without anthracyclines (SMR = 14.8, 95% CI = 4.8 to 34.5). CONCLUSIONS: The risk of death from myocardial infarction after treatment for Hodgkin disease remains high for at least 25 years. The increased risks are related to supradiaphragmatic radiotherapy but may also be related to anthracycline and vincristine treatment.


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