Download Risk of heart failure following Hodgkin lymphoma

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Risk of heart failure following Hodgkin lymphoma
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van Nimwegen FA, Ntentas G, Darby SC, Schaapveld M, Hauptmann M, Lugtenburg PJ, Janus
CPM, Daniels L, van Leeuwen FE, Cutter DJ, Aleman BMP. Risk of heart failure in survivors of
Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines.
Blood. 2017;129(16):2257-2265.
1. Your patient is a 31-year-old female survivor of Hodgkin lymphoma (HL) treated 5 years ago. According to the case-control
study by van Nimwegen and colleagues, which of the following statements about the risk for heart failure (HF) in patients with HL
related to radiation exposure vs no exposure is most accurate?
M Average mean left ventricular dose (MLVD) was not significantly different between case patients and control patients
M There was a marked increase in the risk for HF even at lower doses, up to 25 Gy of mean heart dose (MHD) or up to 15 Gy of MLVD
M The 25-year cumulative risks for HF after MLVDs of 0 to 15 Gy, 16 to 20 Gy, and $21 Gy were 4.4%, 6.2%, and 13.3%,
respectively, in patients not receiving anthracycline
M There was a statistically significant linear dose-response relationship of HF with MLVD, but not with MHD
2. According to the case-control study by van Nimwegen and colleagues, which of the following statements about the risk for HF
in patients with HL related to anthracycline exposure is correct?
M Anthracycline-containing chemotherapy increased HF rate by a factor of 2.83
M There was a significant interaction for HF rate between MLVD and anthracycline-containing chemotherapy
M There was a statistically significant dose-response relationship between cumulative anthracycline dose and HF rate
M Among patients given mediastinal radiotherapy as primary therapy, HF rates were significantly less in those who received
anthracyclines only as primary vs as salvage therapy
3. According to the case-control study by van Nimwegen and colleagues, which of the following statements about the clinical
implications regarding the risk for HF in patients with HL related to radiation and anthracycline exposure is correct?
M There were significant associations of HF risk with cardiovascular risk factors
M Anthracycline doses used currently are typically higher than the doses received by most patients in this study
M Salvage therapy with anthracyclines after primary treatment with mediastinal radiotherapy appears to be less harmful than primary
treatment with mediastinal radiotherapy and anthracyclines
M The findings allow estimation of HF risk for patients before treatment, during radiotherapy planning, and during follow-up
DOI 10.1182/blood-2017-03-771303
2334
© 2017 by The American Society of Hematology
BLOOD, 20 APRIL 2017 x VOLUME 129, NUMBER 16
From www.bloodjournal.org by guest on May 2, 2017. For personal use only.
2017 129: 2334
doi:10.1182/blood-2017-03-771303
Risk of heart failure following Hodgkin lymphoma
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