Pulmonary diseases in patients with classical Hodgkin lymphoma relative to a matched background population: A Danish national cohort study

• Published in: British journal of haematology Vol. 205; no. 2; pp. 542 - 551
• Main Authors: Vandtved, Julie Haugaard, Øvlisen, Andreas Kiesbye, Baech, Joachim, Weinrich, Ulla Møller, Severinsen, Marianne Tang, Maksten, Eva Futtrup, Jakobsen, Lasse Hjort, Glimelius, Ingrid, Kamper, Peter, Hutchings, Martin, Specht, Lena, Dahl‐Sørensen, Rasmus, Christensen, Jacob Haaber, El‐Galaly, Tarec C.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.08.2024
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin; Bleomycin - administration & dosage; Bleomycin - adverse effects; Chemotherapy; Chronic obstructive pulmonary disease; Cohort Studies; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Dacarbazine; Denmark - epidemiology; Doxorubicin; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Etoposide; Female; Hodgkin Disease - drug therapy; Hodgkin Disease - epidemiology; hodgkin lymphoma; Hodgkin's lymphoma; Humans; Incidence; late effects; Lung diseases; Lung Diseases - chemically induced; Lung Diseases - epidemiology; Lung Diseases - etiology; Lymphoma; Male; Medicin och hälsovetenskap; Middle Aged; obstructive lung diseases; Population studies; Prednisone; Procarbazine; Procarbazine - administration & dosage; Procarbazine - adverse effects; pulmonary diseases; pulmonary fibrosis; Risk factors; Survival; Toxicity; Vinblastine; Vincristine; Vincristine - administration & dosage; Vincristine - adverse effects; Vincristine - therapeutic use; Young Adult; Denmark; hodgkin lymphoma; pulmonary diseases; bleomycin; obstructive lung diseases; late effects; pulmonary fibrosis
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/bjh.19475

Summary Late toxicities can impact survivorship in patients with classical Hodgkin lymphoma (cHL) with pulmonary toxicity after bleomycin‐containing chemotherapy being a concern. The incidence of pulmonary diseases was examined in this Danish population‐based study. A total of 1474 adult patients with cHL treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) or BEACOPP (bleomycin, vincristine, etoposide, doxorubicin, cyclophosphamide, procarbazine and prednisone) between 2000 and 2018 were included along with 7370 age‐ and sex‐matched comparators from the background population. Median follow‐up was 8.6 years for the patients. Patients with cHL had increased risk of incident pulmonary diseases (HR 2.91 [95% CI 2.30–3.68]), with a 10‐year cumulative risk of 7.4% versus 2.9% for comparators. Excess risks were observed for interstitial lung diseases (HR 15.84 [95% CI 9.35–26.84]) and chronic obstructive pulmonary disease (HR 1.99 [95% CI 1.43–2.76]), with a 10‐year cumulative risk of 4.1% and 3.5% respectively for patients. No excess risk was observed for asthma (HR 0.82 [95% CI 0.43–1.56]). Risk factors for interstitial lung diseases were age ≥60 years, the presence of B‐symptoms and low albumin. These findings document a significant burden of pulmonary diseases among patients with cHL and emphasize the importance of diagnostic work‐up of pulmonary symptoms. Bleomycin‐induced pulmonary toxicity can impact survivorship in patients with classical Hodgkin lymphoma (cHL). The incidence of pulmonary diseases was examined in this study. A total of 1474 adult patients with cHL treated with ABVD or BEACOPP were included along with 7370 matched comparators. Median follow‐up was 8.6 years for patients with cHL. Patients had increased risk of incident pulmonary diseases (HR 2.91 [95% CI 2.30–3.68]), with a 10‐year cumulative risk of 7.4% versus 2.9% for comparators. Excess risks were observed for interstitial lung diseases (ILDs) (HR 15.84 [95% CI 9.35–26.84]) and chronic obstructive pulmonary disease (HR 1.99 [95% CI 1.43–2.76]), with 10‐year cumulative risk of 4.1% and 3.5% respectively for patients. No excess risk was observed for asthma. Risk factors for ILDs were age ≥60 years, the presence of B‐symptoms and low albumin.