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Testi AM, Al-Jadiry MF, Moleti ML, Uccini S, Al-Darraij AF, Al-Saeed RM, Ghali HH, Sabhan AH, Fadhil SA, Al-Badri SA, Alsaadawi AR, Hameedi AD, Shanshal MH, Al-Agele YS, Al-Saffar FAR, Yaseen NK, Piciocchi A, Marsili G, Al-Hadad SA. Hodgkin Lymphoma in Children: A 16-year Experience at the Children's Welfare Teaching Hospital of Baghdad, Iraq. Mediterr J Hematol Infect Dis 2024; 16:e2024053. [PMID: 38984093 PMCID: PMC11232685 DOI: 10.4084/mjhid.2024.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/16/2024] [Indexed: 07/11/2024] Open
Abstract
Background Childhood Hodgkin lymphoma (HL) is an eminently curable disease. Good outcomes can be achieved even in resource-limited settings, and the focus is increasingly on limiting long-term toxicity. Contemporary treatment incorporates a risk-stratified, response-adapted approach using multiagent chemotherapy with/without low-dose radiotherapy. Many developing countries continue to use ABVD-based regimens due to limited acute toxicity, cost, and ease of delivery. Objective We herein report the outcomes of childhood HL diagnosed and treated in an Iraqi single centre over 16 years. Methods Children ≤14 years old with biopsy-proven HL were enrolled. Most patients received ABVD chemotherapy or COPP/ABV when Dacarbazine was unavailable. Radiotherapy was not available. Results Three hundred-three children were consecutively newly diagnosed with HL; 284 were considered eligible for the retrospective analysis (treatment refusals 9; deaths before therapy 5; initially diagnosed of non-Hodgkin lymphoma 5). ABVD scheme was administered to 184 children (65%), COPP/ABV to 83 (29%), and other schemes to the remaining 17 patients. Complete response (CR) was achieved in 277 (98%); 4 (1.4%) showed disease progression, and 1 had stable disease. Four patients in CR abandoned therapy and were in CR at the time of analysis, 2 died from infection. Relapse occurred in 42 patients (15%). The 15-year OS and EFS are 89.7% and 70.3%, respectively. Conclusion In this single Centre, over 16 years, almost 90% of children suffering from HL survive, despite the numerous limitations in diagnostic procedures, shortage of chemotherapy, no radiotherapy facilities, absence of effective second-line treatments, and finally, therapy abandonment for social and financial reasons.
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Affiliation(s)
- Anna Maria Testi
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Mazin Faisal Al-Jadiry
- College of Medicine-University of Baghdad, Children Welfare Teaching Hospital-Medical City, Pediatrics, Baghdad, Iraq
| | - Maria Luisa Moleti
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stefania Uccini
- Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Hasanein Habeeb Ghali
- College of Medicine-University of Baghdad, Children Welfare Teaching Hospital-Medical City, Pediatrics, Baghdad, Iraq
| | - Ahmed Hatem Sabhan
- Children Welfare Teaching Hospital-Medical City, Oncology Unit, Baghdad, Iraq
| | | | - Safaa Abdulelah Al-Badri
- College of Medicine-Wasit University, Children’s Welfare Teaching Hospital-PaediatricOncology Unit, Medical City, Pediatrics, Baghdad, Iraq
| | | | - Ameer Dh Hameedi
- College of Medicine, University of Baghdad, Pathology, Baghdad, Iraq
| | | | | | | | - Nihal Khalid Yaseen
- Children Welfare Teaching Hospital-Medical City, Oncology Unit, Baghdad, Iraq
| | | | | | - Salma Abbas Al-Hadad
- College of Medicine-University of Baghdad, Children Welfare Teaching Hospital-Medical City, Pediatrics, Baghdad, Iraq
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Shen R, Zou T. Association Between Cancer and Cardiovascular Toxicity: A Nationwide Cross-Sectional Study on NHANES 1999-2018. Cardiovasc Toxicol 2024; 24:351-364. [PMID: 38466544 DOI: 10.1007/s12012-024-09845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
There is a dearth of evidence pertaining to the relationship of cardiovascular disease (CVD) and its subtype with adjudicated cancer, thereby limiting our understanding of the heightened risk of CVD resulting from long-term complications of cancer and its therapies. The aim of this study was to quantify the risks of CVD and its subtypes in adult cancer survivors compared with cancer-free controls in a nationwide cross-sectional study on Continuous National Health and Nutrition Examination Survey (NHANES). We included 44,442 participants ranging in age from 20 to 85 years. Cancer and CVD diagnoses were ascertained via the household questionnaires. The association of cancer status with the risk of CVD and CVD subtype was examined using weighted logistic regression. Stratification analyses were also performed by age, sex, race, marital status, income status, educational level, and hyperlipidemia. The Wald test was used to calculate P-value for interaction. A total of 4178 participants have cancer, while 4829 participants had CVD, respectively. In the multivariable-adjusted model, the cancer was consistently linked to an elevated risk of CVD. Stratification analyses showed that stronger association between cancer status and CVD risk was found in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. Our study confirmed that cancer participants were strongly linked to living with CVD, independent of traditional cardiovascular risk factors, especially in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. There exists a pressing requirement to establish effective strategies for the prevention of CVD within this population characterized by a heightened risk.
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Affiliation(s)
- Ruihuan Shen
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Tong Zou
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
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Shell D. Cardiac surgery for radiation associated heart disease in Hodgkin lymphoma patients. Best Pract Res Clin Haematol 2023; 36:101515. [PMID: 38092474 DOI: 10.1016/j.beha.2023.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 12/18/2023]
Abstract
Much of the modern focus of Hodgkin's Lymphoma (HL) treatment involves the prevention of secondary organ injury. Despite rationalisations of radiotherapy fields, many patients still develop late radiation-related cardiotoxicity that is severe and requires interventional management. No guidelines exist to direct management of these complex patients who often present with multiple concurrent cardiac pathologies. Despite possessing a greater mortality risk than in the general population, cardiac surgery has an important role in treating radiation-associated heart disease. This review summarises the body of literature surrounding cardiac surgery in HL survivors post-radiotherapy, highlighting the benefits and risks unique to this cohort. The pathophysiology and presentation of radiation-associated heart disease is also explored in relation to HL patients.
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Affiliation(s)
- Daniel Shell
- Department of Cardiothoracic Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
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Popit M, Zaletel M, Žvan B, Zaletel LZ. Long-Term Adverse Effects of Neck Radiotherapy in Childhood on the Carotid Arteries in Survivors of Hodgkin Lymphoma. Cancers (Basel) 2023; 15:3992. [PMID: 37568807 PMCID: PMC10417543 DOI: 10.3390/cancers15153992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Survivors of Hodgkin lymphoma are recognized to have an increased risk of stroke and carotid artery disease owing to neck irradiation (RT). However, it remains unclear whether the vascular modifications induced by the treatment of Hodgkin lymphoma during childhood persist over the long term. METHODS Our matched study involved 79 survivors of Hodgkin lymphoma in childhood who received neck RT and 57 healthy controls. Parameters of arterial stiffness (AS), intima-media thickness (IMT), and flow-mediated dilation (FMD) of carotid arteries were assessed using ultrasound. RESULTS Our patient cohort demonstrated a significant increase in AS compared to controls (p < 0.05), though no such disparity was observed for FMD (p = 0.111). Neck RT intensified AS (B = 0.037, p = 0.000), while anthracyclines attenuated it (B = -0.803, p = 0.000). Multivariate analysis revealed a positive correlation between neck RT (p < 0.001) and AS. However, we found no significant association between neck RT and FMD (p = 0.277). We identified a substantial positive correlation between the dose of neck RT and AS. CONCLUSIONS Vascular changes in survivors of childhood Hodgkin lymphoma after neck RT seem to be long-term. Therefore, these patients may have an increased risk of stroke. We suggest refinement of international guidelines according to our results.
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Affiliation(s)
- Matjaž Popit
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, 9000 Murska Sobota, Slovenia;
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (M.Z.); (B.Ž.)
| | - Marjan Zaletel
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (M.Z.); (B.Ž.)
- Department of Vascular Neurology and Intensive Neurological Therapy, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Bojana Žvan
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (M.Z.); (B.Ž.)
- Department of Vascular Neurology and Intensive Neurological Therapy, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Lorna Zadravec Zaletel
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (M.Z.); (B.Ž.)
- Radiotherapy Department, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
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