%0 Journal Article
%T Therapy-Related Late Adverse Events in Hodgkin¡¯s Lymphoma
%A Manuel Gotti
%A Valeria Fiaccadori
%A Elisa Bono
%A Benedetta Landini
%A Marzia Varettoni
%A Luca Arcaini
%A Maurizio Bonfichi
%J Lymphoma
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/952698
%X Hodgkin's lymphoma (HL) is one of the most curable hematologic diseases with an overall response rate over 80%. However, despite this therapeutic efficacy, HL survivors show a higher morbidity and mortality than other people of the same age because of long-term therapy-related events. In the last decades, many efforts have been made to reduce these effects through the reduction of chemotherapy dose, the use of less toxic chemotherapeutic agents, and the introduction of new radiation techniques. In this paper, we will describe the main long-term effects related to chemotherapy and radiotherapy for HL, the efforts to reduce toxicity made in the last years, and the clinical aspects which have to be taken into consideration in the followup of these patients. 1. Introduction During the last decades, survival of patients (pts) treated for classical Hodgkin¡¯s lymphoma (HL) has improved substantially, getting nowadays to an overall cure rate of 80%¨C85%, with peaks of more than 90% in early stages. Despite high rates of response, HL survivors have increased morbidity and mortality compared to the general population because of therapy-related side effects. Late complications of treatment are reported since the 70s and include cardiovascular diseases, lung diseases, endocrine abnormalities and secondary malignancies [1, 2]. The aim of this paper is to systematically summarize the available data on long-term events in patients treated for HL. To this aim, we performed a systematic PubMed search (http://www.pubmed.gov/) using the keywords ¡°long-term events,¡± ¡°Hodgkin¡¯s lymphoma,¡± and ¡°late toxicity.¡± All relevant articles were included and were reviewed with reference to cardiovascular and pulmonary diseases, thyroid and fertility dysfunctions, and second cancers related to chemotherapy and radiotherapy. 2. Cardiovascular Diseases In HL pts treated with anthracyclines and/or mediastinal radiotherapy (RT), an increased mortality due to cardiac diseases has been frequently reported [3¨C5]. Anthracyclines can cause cardiomyopathy, valvular and conduction defects [6]. These clinical manifestations are caused by myocyte loss and interstitial fibrosis leading to decreased left ventricle (LV) contractility, reduced ventricular wall thickness, and progressive LV dilation. Cancer survivors who received anthracycline combined with RT treatment may have an impaired quality of life, develop heart failure, or eventually die for cardiac complications. Earlier studies have demonstrated that the risk of developing clinical heart failure 15 years after anthracycline therapy for
%U http://www.hindawi.com/journals/lymph/2013/952698/