The following is a summary of “Development and Validation of Risk Prediction Models for Coronary Heart Disease and Heart Failure After Treatment for Hodgkin Lymphoma,” published in the January 2023 issue of Oncology by Vries, et al.
Childhood cancer survivors have been the main target of prior attempts to estimate absolute risk of treatment-related cardiovascular disorders (CVDs). For survivors of adolescent/adult Hodgkin lymphoma (HL), researchers to create prediction models for the risk of coronary heart disease (CHD) and heart failure (HF).
They employed a multicenter cohort of 1,433 5-year HL survivors treated between 1965 and 2000, aged 18 to 50 at HL diagnosis, with comprehensive data on chemotherapy regimens delivered, radiation volumes and dosages, and cardiovascular follow-up, for the creation of the model. Covariate-adjusted cumulative incidences for CHD and HF were calculated using cause-specific hazard models in the context of competing risks of mortality from causes other than CHD and HF. As predictors, they looked at age at HL diagnosis, sex, smoking status, radiotherapy, and anthracycline treatment. Using a Canadian cohort of 708 HL survivors treated between 1988 and 2004 and aged 18 to 50 at HL diagnosis, external validation for the CHD model was carried out.
About 341 survivors had CHD after a median follow-up of 24 years, and 102 had HF. With moderate to good overall calibration and moderate discrimination (areas under the curve: 0.68-0.74), they were able to predict CHD and HF risk at 20 and 30 years following treatment. It was supported by external validation for the CHD model (areas under the curve: 0.73-0.74). Based on the model that included the recommended mediastinal radiation dosage, 30-year risks for CHD and HF varied depending on risk variables from 4% to 78% and 3% to 46%, respectively.
With good overall calibration and modest discrimination, they created and validated CHD and HF prediction models. The models helped determine which HL survivors would benefit from focused CVD screening and early treatment of CVD risk factors.
Reference: ascopubs.org/doi/full/10.1200/JCO.21.02613