NOTE, original article title: Limited, but not eliminated, excess long-term morbidity in stage I-IIA Hodgkin lymphoma treated with doxorubicin, bleomycin, vinblastine, and dacarbazine and limited-field radiotherapy

Researchers intended to assess long-term toxicity from modern limited-field (LF)-radiotherapy (RT) after two or four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for classical Hodgkin lymphoma (cHL). They noted that relative to toxicity due to earlier RT techniques, excess morbidity was not eliminated, but was lower than previously documented. The increased risk of DRS (diseases of the respiratory system) was shown to be driven by asthma diagnosis, which could partly be explained by misdiagnosis of persisting pulmonary toxicity.

• When treating early-stage cHL, it is important to balance disease control and toxicity from chemotherapy and RT.

• Patients with cHL treated with two or four cycles of ABVD and 30 Gy LF-RT during 1999-2005 in Sweden were analyzed, including 215 patients and 860 comparators matched for age, gender, and region of residence.

• Relative to comparators, patients had higher risk of a malignancy [hazard ratio (HR) 1.5] as well as higher risk for diseases of the circulatory system (DCS) (1.5) and for DRS (2.6).

• Of individual diagnoses in DCS, only venous thromboembolism was noted to be statistically significantly elevated.

• The elevated HR for venous thromboembolism decreased, if the first 6 months (ie, time of active treatment for cHL) were excluded and censoring at relapse of cHL or diagnosis of any cancer.

• The majority of the excess risk for DRS comprised asthma, HR 3.5.

• Significantly younger age of patients diagnosed with DRS was evident than comparators.