CARDIOPULMONARY SEQUELAE AFTER TREATMENT FOR HODGKINS-DISEASE - INCREASED RISK IN FEMALES

Background: The treatment of Hodgkin's disease (HD) involves irradiati on and chemotherapy. Both modalities may cause heart and lung injury. We aimed to assess 1) the occurrence of such injury, 2) the extent to which combined versus single-organ-affection resulted in disability, a nd 3) whether determinants for cardiopulmonary injury could be identif ied. Patients and methods: A national cohort (n = 116) of HD patients (mean age 37 +/- 7 (SD) years, 67 males) was examined by interview, ec hocardiography, bicycle exercise test and lung function tests, 5-13 ye ars after mediastinal irradiation with or without chemotherapy. Result s: Cardiac, pulmonary or combined sequelae occurred, respectively, in 21%, 15% and 19% of the patients affecting 75% of the females versus 4 1% of the males (P < 0.001). Of the patients with combined sequelae, 2 7% were disabled versus 4% of the rest (P < 0.05). Combined sequelae w as associated with dyspnoea (P < 0.001) and reduced maximal exercise h eart rate (P < 0.05). Compared to males, females had an increased risk of heart valve regurgitation (46% versus 16%, P < 0.001), pericardial thickening (22% versus 10%, P = 0.07) and reduced gas transfer (41% v ersus 22%, P = 0.03). Female gender was a significant risk factor for cardiac and/or pulmonary sequelae (OR 6.1, 95% CI 2.4-15.7), whereas a ge, follow-up period, smoking habits, histology, bulky mediastinal dis ease, radiation dose and chemotherapy were not. Mean exercise work cap acity and O-2-saturation were within normal limits. Conclusions: Altho ugh cardiac and/or pulmonary sequelae were detected in more than half of the patients, only combined injury was associated with disability, dyspnoea and reduced performance. Females had an increased risk of car diopulmonary sequelae, which could not be explained by treatment-relat ed differences between the genders.