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From www.bloodjournal.org by guest on May 2, 2017. For personal use only. Continuing Medical Education (CME) Questions Risk of heart failure following Hodgkin lymphoma To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME) credit, please go to http://www.medscape.org/journal/blood. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on http://www.medscape.org. If you are not registered on http://www.medscape.org, please click on the “Register” link on the right hand side of the website. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding this activity, contact the accredited provider, [email protected]. For technical assistance, contact [email protected]. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please go to https://www.ama-assn.org. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the AMA PRA CME credit certificate, and present it to your national medical association for review. 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 Updated information and services can be found at: http://www.bloodjournal.org/content/129/16/2334.citation.full.html Articles on similar topics can be found in the following Blood collections CME article (172 articles) Free Research Articles (4463 articles) Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved.