Hodgkin Lymphoma Survivors Face Nearly Twice the Mortality of the General Population
核心洞察
Adult survivors of Hodgkin lymphoma (搜索) had nearly twice the mortality of the general U.S. population, with a standardized mortality ratio of 1.96 (95% CI: 1.89–2.03).
The study analyzed 20,057 long-term survivors diagnosed between 2000 and 2017, observing 2,899 deaths versus 1,480.8 expected.
While malignant conditions drove relative mortality risk, cardiovascular and other noncancer causes accounted for the greatest absolute excess in deaths.
Adult survivors of Hodgkin lymphoma (搜索) face nearly twice the mortality of the general United States population, according to a population-based retrospective cohort study of 20,057 long-term survivors published in JAMA Network Open. The research, led by Bryan Valcarcel, M.D., instructor, and Luis Malpica Castillo, M.D., associate professor, both of Lymphoma & Myeloma at The University of Texas MD Anderson Cancer Center, found that survivors experienced a standardized mortality ratio of 1.96 (95% confidence interval: 1.89–2.03).
The analysis examined adults aged 20 years or older who were diagnosed with a first primary Hodgkin lymphoma (搜索) between 2000 and 2017, received chemotherapy (搜索) with or without radiotherapy (搜索), and survived at least 5 years after diagnosis. Follow-up was available up to December 2023. Researchers used data from 16 population-based registries within the Surveillance, Epidemiology, and End Results (SEER) programme to assess excess all-cause mortality among long-term survivors, comparing observed deaths with expected deaths in the general U.S. population while accounting for age, sex, race and ethnicity, and calendar period.
Study Population and Key Findings
Among the 20,057 survivors, the median age at diagnosis was 36 years. Men accounted for 53.7% of the cohort, while 15.0% were Hispanic, 10.3% were non-Hispanic Black, and 69.2% were non-Hispanic White. Nodular sclerosis was reported in 63.4% of patients.
During follow-up, 2,899 deaths were observed compared with 1,480.8 deaths expected in the general population, corresponding to the standardized mortality ratio of 1.96. The excess absolute risk was 81.9 additional deaths per 10,000 patient-years (95% confidence interval: 75.8–88.0).
Relative mortality risk was higher across all major causes of death, with malignant conditions representing the main contributors to relative mortality. However, the largest absolute number of excess deaths resulted from other noncancer causes and cardiovascular causes. In long-term survivors, non-cancer causes represented the largest cumulative mortality burden, followed by other cancers, cardiovascular disease, and recurrence of Hodgkin lymphoma (搜索).
Elevated Risk Persists Beyond a Decade
The increased risk of death was present not only in five-year survivors but also in those who had survived at least 10 years. The highest relative risks were seen among younger adults diagnosed between ages 20 and 39, and among several racial and ethnic minority groups. Mortality rates were lower among patients diagnosed in recent years, reflecting ongoing progress in treatment.
"Thanks to advances in treatment, patients are living longer. However, our findings confirm comprehensive survivorship care focused on cardiovascular health, secondary cancers and other chronic conditions are important to improve long-term survival outcomes," Malpica said.
Implications for Survivorship Care
The findings highlighted persistent mortality risks among adults who survived Hodgkin lymphoma (搜索) for at least 5 years, a particularly relevant concern as improvements in treatment have contributed to a growing population of long-term survivors. Previous mortality estimates have often been based on childhood cancer survivors, patients assessed during earlier follow-up, or populations treated before contemporary treatment strategies became widely adopted. The present analysis therefore provided population-based estimates specifically focused on adults diagnosed during a more recent treatment era.
The findings suggested that survivorship care should remain attentive to both cancer-related and noncancer causes of mortality. Although malignant conditions contributed substantially to relative mortality risk, cardiovascular and other noncancer causes accounted for the greatest absolute excess in deaths.
At UT MD Anderson, patients receive care in the Lymphoma Survivorship Clinic for long-term follow-up. Advanced practice providers help ensure the health of Hodgkin lymphoma (搜索) survivors by routinely monitoring for disease recurrence, screening for secondary cancers, monitoring and managing the effects of treatment, offering psychosocial support services, and collaborating with primary care providers to manage patients' health conditions. Patients also have access to additional services, such as cardiopulmonary monitoring, a bone health clinic, integrative medicine, wellness counseling, pain management, and vaccine clinics.