Clinically significant delayed cardiac morbidity following ABVD chemotherapy for Hodgkin lymphoma: A population-based study.
Bibliographic record
Abstract
8059 Background: Doxorubicin-based chemotherapy is standard treatment for Hodgkin lymphoma (HL). Prior studies of cardiotoxicity after HL primarily reflect treatment with outdated chemotherapy or radiation therapy alone. Methods: We conducted a case-cohort study of 3,964 adult patients diagnosed with HL 1988-2003, identified from Ontario's cancer registry. Cardiac-related hospitalization (CH) after HL was the outcome, identified from a national registry. Treatment and risk factor data were abstracted for a random sample (N = 1,108 subcohort) plus additional patients in the source cohort who had CH. Competing risk models were used to identify risk factors and estimate the cumulative incidence of CH following HL. Expected rates were based on a general population cohort matched 6:1 with HL patients on sex, age, and neighbourhood. Results: Median F/U = 9.9 years (0.1-19 years). Median age at HL = 35 yrs. 40% of the subcohort received doxorubicin-based chemotherapy alone; 32% received doxorubicin+mediastinal RT. Significant predictors of post-HL CH were the presence of pre-existing heart disease (RR 4.88), diabetes (RR 4.33), elevated cholesterol (RR 3.91), hypertension (RR 2.34), male sex (RR 1.61), smoking (RR 1.30), obesity (RR 1.96), and increasing attained age (all p values <0.05). Among those with no prior heart disease (91% of patients), CH risk following treatment with doxorubicin-based chemotherapy+mediastinal RT was significantly higher than after doxorubicin-based chemotherapy alone, adjusting for other significant factors (HR=1.8, p=0.003). Findings were similar when analysis was restricted to ABVD specifically. For males treated at age 35 with ABVD alone or ABVD+mediastinal RT, the estimated 10-yr incidence of CH were 5.5% and 9.2% respectively, compared to 2.2% expected in the general population. For females age 35 at HL, these rates were 3.3% and 5.6%, compared to 1.3% expected. Conclusions: ABVD is associated with an increased risk of significant delayed cardiac morbidity in adults with HL. This risk is greater with the addition of mediastinal RT. These findings support the implementation clinical trial results that limit cardiotoxic exposures for these patients. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".