Cardiac and pulmonary late effects in Hodgkin’s lymphoma survivors in The Republic of North Macedonia

Abstract

Background: Survivors with HL express higher morbidity and mortality rates than the general population of comparable age, mainly because of the late cardiological and pulmonary complications associated with the duration and character of previously administered therapy. The objectives of this study are to determine changes in cardiac and pulmonary functions in patients with Hodgkin’s lymphoma treated with chemotherapy with or without mediastinal radiation therapy. Patients and Methods: The study includes 287 patients with Hodgkin's lymphoma. An analysis of the ECG, echocardiography and spirometric examinations were utilized for the detection of potential cardiac and pulmonary late complications, resulting from the treatment of patients, following long-term remissions. Results: Late adverse effects are a factor that further increases morbidity and mortality in our surviving HL patients. In 20.8% of the patients, heart disease was detected. It is confirmed that the total dose of doxorubicin influences the onset of late cardiac complications with statistical significance. Late cardiac adverse events occurred in 17.3% of our patients, who received a cumulative dose of doxorubicin greater than 200 mg/sq.m. Patients who received additional mediastinal radiotherapy, had an incidence of heart disease twice higher than patients who received chemotherapy only. In our analyzed series of patients, 24.7% manifested pulmonary toxicity and in 12.7%, a severe degree of pulmonary ventilatory failure was detected. With regard to the latter findings, we also confirm that patients who are receiving bleomycin develop significantly more pulmonary disorders, compared with patients who are receiving chemotherapy regimens without bleomycin. Conclusion: Improvements have been introduced in formulating certain drugs, so that cardiotoxic effects are reduced or with diminished intensity, or even completely omitting them and replacing them with a less or non-toxic drug. With regard to radiotherapy, size and shape of radiation fields can be precisely customized and dose reduction became acceptable. Despite the progress achieved regarding treatment outcomes in HL patients, due to the optimization of therapeutic protocols, the issue of potential side effects, arising as a treatment consequence, remains a concern.