Survivorship and Patients Perspective
M. Cepelova1, J. Kruseova1, A. Luks1, P. Cepela2, J. Potockova2, P. Kraml2
1 Department of Pediatric Hematology and Oncology, 2nd Medical Faculty Charles University and University Hospital in Motol, Prague, Czech Republic, 2 2nd Department of Internal Medicine, 3rd Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
Background: The development of curative therapies has led to a growing population of chilhood Hodgkin lymphoma survivors. Cardiovascular events with long-term morbidity and early mortality are among most important adverse events. Seriousness of these late adverse events could be reduced only by their early recognition and also by early recommendations of preventive measurements for modifiable cardiovascular risk factors.
Methods: The aim of our prospective observation study was to compare the lipid profiles, markers of oxidative stress and endothelial dysfunction together with evaluation of atherosclerotic changes at main carotid artery between the long-term survivors of childhood Hodgkin lymphoma (HL CCS) more than 10 years after the treatment and the matched group of healthy volunteers at the age of 25–40 years.
Patients: Eighty long-term survivors of childhood Hodgkin lymphoma (45 males, 35 females) and eighty age matched healthy volunteers (43 males, 37 females) were recruited. All underwent clinical examination, completed questionnaire collecting information on family history of cardiovascular diseases, subject's health habits and medical conditions, underwent ultrasound examination of the carotid arteries and their blood specimens were analyzed. Information on previous radiotherapy and chemotherapy in all HL CCS was gathered.
Results: Compared to healthy subjects, Hodgkin lymphoma survivors had significantly higher levels of total cholesterol (5.23 ± 1.09 vs. 4.74 ± 0.76 mmol/l), LDL-cholesterol (3.06 ± 0.92 vs. 2.63 ± 0.71 mmol/l), nonHDL-cholesterol (3.69 ± 1.12 vs. 3.08 ± 0.82 mmol/l), triglycerides (1.42 ± 1.07 vs. 1.02 ± 0.52 mmol/l), glucose (5.28 ± 0.51 vs. 4.92 ± 0.38 mmol/l), insulin (12.21 ± 8.14 vs. 8.37 ± 3.84 mU/l), HOMA IR (2.92 ± 2.03 vs. 1.87 ± 0.94), increased IMT (5.47 ± 0.86 vs. 4.86 ± 0.79 mm) as well as markers of arterial stiffness – SI (5.64 ± 2.69 vs. 3.79 ± 1.16) and YEM (1028.88 ± 523.35 vs. 749.97 ± 321.07), all p < 0,01.
Conclusions: HL CCS compared to healthy controls of the same age had significantly higher plasma lipid parameters, higher indicators of insulin resistance as well as markers of atherosclerosis progression and arterial stiffness. Further analyses and correlation of the findings with lifestyle factors and received cancer treatment are ongoing. New recommendations for follow-up examinations and blood analyses together with recommendations for early therapeutic interventions in the HL CCS population are necessary.