Temporal Trends in Mortality From Diseases of the Circulatory System After Treatment for Hodgkin Lymphoma: A Population-Based Cohort Study in Sweden (1973 to 2006)

PurposeHodgkin lymphoma (HL) survival in Sweden has improved dramatically over the last 40 years, but little is known about the extent to which efforts aimed at reducing long-term treatment-related mortality have contributed to the improved prognosis.MethodsWe used population-based data from Sweden to estimate the contribution of treatment-related mortality caused by diseases of the circulatory system (DCS) to temporal trends in excess HL mortality among 5,462 patients diagnosed at ages 19 to 80 between 1973 and 2006. Flexible parametric survival models were used to estimate excess mortality. In addition, we used recent advances in statistical methodology to estimate excess mortality in the presence of competing causes of death.ResultsExcess DCS mortality within 20 years after diagnosis has decreased continually since the mid-1980s and is expected to further decrease among patients diagnosed in the modern era. Age at diagnosis and sex were important predictors for excess DCS mortality, with advanced age and male sex being associated with higher excess DCS mortality. However, when accounting for competing causes of death, we found that excess DCS mortality constitutes a relatively small proportion of the overall mortality among patients with HL in Sweden.ConclusionExcess DCS mortality is no longer a common source of mortality among Swedish patients with HL. The main causes of death among long-term survivors today are causes other than HL, although other (non-DCS) excess mortality also persists for as long as 20 years after diagnosis, particularly among older patients.

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A Network of Treatment Centers and Standardisation of Treatment Protocol Leads to Reduction in Mortality in Acute Promyelocytic Leukemia (APL)

Blood ◽

10.1182/blood.v120.21.4317.4317 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4317-4317 ◽

Cited By ~ 1

Author(s):

Anand P. Jillella ◽

Farrukh Awan ◽

Ravindra B. Kolhe ◽

Jeremy M Pantin ◽

Devi D Morrison ◽

...

Keyword(s):

High Risk ◽

High Mortality ◽

Causes Of Death ◽

Population Based ◽

Low Risk ◽

Recent Analysis ◽

Cumulative Survival ◽

Treatment Related Mortality ◽

Related Mortality

Abstract Abstract 4317 Background: APL is widely accepted as a curable leukemia with most multi-institutional studies showing very low treatment related mortality. This is in contrast to treatment in clinical practice outside the study population where the treatment related mortality is higher. A few recent population based studies show that mortality maybe as high as 30% in APL patients during induction. A recent analysis of SEER data from 13 population-based cancer registries with 1400 APL patients in the US showed that 17% of all patients and 24% of patients greater than 55 years of age die within one month of diagnosis. Swedish registry data and Brazilian data also show this high mortality during induction. The most common causes of death are bleeding, infection, differentiation syndrome and multi-organ failure. Patients who survive induction have an excellent cure rate with few late relapses. Hence, decreasing early deaths is a high priority both at experienced as well as smaller centers with limited leukemia treatment experience in this highly curable disease. Methods: At Georgia Health Sciences University, between 7/2005 and 6/2009, 19 patients were diagnosed with APL. Seven patients (5 high-risk and 2 low-risk) died during induction resulting in an unusually high mortality rate of 37%. All patients who survived induction are still in remission at present. The high early death rate prompted us to develop a simple, 2 page treatment algorithm that focuses on quick diagnosis, prompt initiation of therapy, and proactive and aggressive management of all the major causes of death during induction. We also developed a network of physicians in smaller community based treatment centers and gave them access to our protocol and helped them manage these patients in the induction period with the hypothesis that this standardized treatment approach will result in decreasing induction mortality. Results: From 11/2010 to 7/2012, we treated 5 patients at GHSU and helped manage 4 patients at 2 outreach sites. The age range was 30 to 60; two patients were high-risk, 6 intermediate- and one low-risk. In the pre-algorithm cohort the cumulative survival was 63.1% at 1 year with all deaths happening within 31 days. In contrast, after the implementation of a standardized algorithm the cumulative survival was 100% with no deaths during the induction or subsequent follow-up period, log rank p-value=0.05, with a median follow-up of more than 4-years in surviving patients. Conclusions: While we recognize that this is a small cohort, our own experience and a similar approach pioneered by investigators in Brazil clearly shows that this centralized, algorithm-based management under the direct supervision of a leukemia expert can be an effective intervention to decrease early deaths in APL. Based on the Brazilian experience an international consortium was formed to reduce the mortality and interim data show a reduction in early mortality to 7.5% with this networking of treatment centers. We believe our experience warrants large scale implementation with development of a network of physicians and standardization of treatment in the United States to improve early outcomes in this highly curable leukemia. Disclosures: Awan: Allos Therapeutics: Speakers Bureau.

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Excess mortality related to circulatory system diseases and diabetes mellitus among Italian AIDS patients vs. non-AIDS population: a population-based cohort study using the multiple causes-of-death approach

BMC Infectious Diseases ◽

10.1186/s12879-018-3336-x ◽

2018 ◽

Vol 18 (1) ◽

Author(s):

Barbara Suligoi ◽

Saverio Virdone ◽

Martina Taborelli ◽

Luisa Frova ◽

Enrico Grande ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Causes Of Death ◽

Excess Mortality ◽

Circulatory System ◽

Population Based ◽

Aids Patients ◽

Multiple Causes Of Death ◽

Circulatory System Diseases ◽

Multiple Causes

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Excess Mortality Among 10-Year Survivors of Classical Hodgkin Lymphoma in Adolescents and Young Adults

Blood ◽

10.1182/blood.v128.22.694.694 ◽

2016 ◽

Vol 128 (22) ◽

pp. 694-694

Author(s):

Ana Xavier ◽

Luciano J. Costa

Keyword(s):

Cardiovascular Disease ◽

Young Adults ◽

Cardiovascular Diseases ◽

Hodgkin Lymphoma ◽

Causes Of Death ◽

Excess Mortality ◽

Mortality Rates ◽

Classical Hodgkin Lymphoma

Background: Adolescents and young adults (AYA) surviving classical Hodgkin Lymphoma (cHL) commonly face significant treatment-related morbidity that can result in premature death. It is not known if changes in therapy in recent years have resulted in reduction of excess mortality among long-term survivors of AYA-cHL. Methods: We used data from the National Cancer Institute's Surveillance Epidemiology and End Results program (SEER-18) to determine the excess mortality rate (EMR) for 10-year survivors of cHL. We included patients age 15-39 years diagnosed with cHL as first malignant neoplasm from 1993 until 2003. Cases reported from death certificates or autopsy only were excluded. Follow up was updated at the end of 2013. EMR was calculated using the difference between the observed mortality in the cohort of interest and the adjusted expected mortality among age, gender and race-matched individuals in the general population. Results: A total of 6,480 cases of cHL were included in the analysis with median follow up of 42.5 months. Median age of patients was 27 years at the time of diagnosis, 3,172 (48.9%) were male, 4,405 (68%) had stage I or II, 1,750 (27%) had stage III or IV, and in 325 (5%) cases stage was not available. Most patients were non-Hispanic white (4,783, 73.8%), 761 (11.7%) Hispanic, 615 (9.5%) non-Hispanic black, 276 (4.3%) other ethnicity, and 45 (0.7%) unknown. Five thousand and sixty eight (78.2%) had nodular sclerosis cHL, 616 (9.5%) had mixed-cellularity cHL, 606 (9.4%) had cHL non-otherwise specified, 153 (2.4%) had lymphocyte-rich cHL, and 37 (0.57%) had lymphocyte depleted cHL. The 15-year, 18-year, and 20-year EMR for 10-year survivors was 2.19% (95% C.I, 1.69%-2.86%), 3.48% (95% C.I. 2.57%-4.64%) and 4.07% (95% C.I. 2.53%-6.52%), respectively. EMR among 10 year AYA cHL survivors with diagnosis between 1993 and 2003 was substantially improved when compared to a similar cohort of 5,870 survivors with diagnosis between 1973 and 1992 (Figure 1). EMR at 15 and 18 years of diagnosis was higher among survivors of stage III-IV cHL than among survivors of stages I-II (Figure 2a), and higher at 15 years among males than female survivors (Figure 2b). Use of radiation therapy for early stage disease did not seem to affect the risk of excess mortality among 10-year survivors (Table). Causes of death were similar for stages I-II vs. stages III-IV. Most common causes of death were second malignancy (27.2%), cardiovascular disease (19%), and Hodgkin lymphoma (18.5%). Among male survivors there was a higher proportion of deaths due to cardiovascular disease (23.7% vs. 11.5%, p <0.038). Conclusion: Excess mortality rates for 10-year survivors of AYA-cHL has decreased with adoption of less toxic therapies. However, mortality rates continue high for several years for long term AYA HL survivors, mainly due to second malignancies and cardiovascular diseases. Less toxic therapies, control of cardiovascular diseases and implementation of cancer prevention programs for survivors of AYA-cHL are needed. Table. Table. Disclosures Costa: Sanofi: Honoraria, Research Funding.

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Late treatment-related mortality versus competing causes of death after allogeneic transplantation for myelodysplastic syndromes and secondary acute myeloid leukemia

Leukemia ◽

10.1038/s41375-018-0302-y ◽

2018 ◽

Vol 33 (3) ◽

pp. 686-695 ◽

Cited By ~ 7

Author(s):

Johannes Schetelig ◽

Liesbeth C. de Wreede ◽

Michel van Gelder ◽

Linda Koster ◽

Jürgen Finke ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Causes Of Death ◽

Allogeneic Transplantation ◽

Secondary Acute Myeloid Leukemia ◽

Late Treatment ◽

Competing Causes ◽

Treatment Related Mortality ◽

Related Mortality ◽

Acute Myeloid

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Induction death and treatment-related mortality in first remission of children with acute lymphoblastic leukemia: a population-based analysis of the Austrian Berlin-Frankfurt-Münster study group

Leukemia ◽

10.1038/leu.2009.12 ◽

2009 ◽

Vol 23 (7) ◽

pp. 1264-1269 ◽

Cited By ~ 45

Author(s):

C Prucker ◽

◽

A Attarbaschi ◽

C Peters ◽

M N Dworzak ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Population Based ◽

Study Group ◽

First Remission ◽

Treatment Related Mortality ◽

Related Mortality

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Hepatitis B virus-related mortality in rheumatoid arthritis patients undergoing long-term low-dose glucocorticoid treatment: A population-based study

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2017.07.004 ◽

2018 ◽

Vol 117 (7) ◽

pp. 566-571 ◽

Cited By ~ 4

Author(s):

Sheng-Shun Yang ◽

Chin-Tun Hung ◽

Shu-Fen Li ◽

Horng-Mo Lee ◽

Yueh-Chin Chung ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Low Dose ◽

Population Based ◽

Glucocorticoid Treatment ◽

Population Based Study ◽

B Virus ◽

Related Mortality

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Temporal trends in treatment‐related incidence of diseases of the circulatory system among Hodgkin lymphoma patients

International Journal of Cancer ◽

10.1002/ijc.32142 ◽

2019 ◽

Vol 145 (5) ◽

pp. 1200-1208

Author(s):

Caroline E. Weibull ◽

Magnus Björkholm ◽

Ingrid Glimelius ◽

Paul C. Lambert ◽

Therese M. L. Andersson ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Temporal Trends ◽

Circulatory System

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Treatment-Related Mortality in Patients With Advanced-Stage Hodgkin Lymphoma: An Analysis of the German Hodgkin Study Group

Journal of Clinical Oncology ◽

10.1200/jco.2012.47.9774 ◽

2013 ◽

Vol 31 (22) ◽

pp. 2819-2824 ◽

Cited By ~ 38

Author(s):

Diana Wongso ◽

Michael Fuchs ◽

Annette Plütschow ◽

Beate Klimm ◽

Stephanie Sasse ◽

...

Keyword(s):

Risk Factors ◽

Hodgkin Lymphoma ◽

Individual Risk ◽

Tumor Control ◽

Poor Performance Status ◽

Study Group ◽

Advanced Stage ◽

German Hodgkin Study Group ◽

Treatment Related Mortality ◽

Related Mortality

Purpose The introduction of BEACOPPescalated (escalated-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) has significantly improved tumor control and overall survival in patients with advanced-stage Hodgkin lymphoma. However, this regimen has also been associated with higher treatment-related mortality (TRM). Thus, we analyzed clinical course and risk factors associated with TRM during treatment with BEACOPPescalated. Patients and Methods In this retrospective analysis, we investigated incidence, clinical features, and risk factors for BEACOPPescalated-associated TRM in the German Hodgkin Study Group trials HD9, HD12, and HD15. Results Among a total of 3,402 patients, TRM of 1.9% (64 of 3,402) was mainly related to neutropenic infections (n = 56; 87.5%). Twenty of 64 events occurred during the first course of BEACOPPescalated (31.3%). Higher risk of TRM was seen in patients age ≥ 40 years with poor performance status (PS) and in patients age ≥ 50 years. PS and age were then used to construct a new risk score; those with a score ≥ 2 had TRM of 7.1%, whereas patients who scored 0 or 1 had TRM of 0.9%. Conclusion The individual risk of TRM associated with BEACOPPescalated can be predicted by a simple algorithm based on age and PS. High-risk patients should receive special clinical attention.

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