242 Late Effects in Survivors Treated for Lymphoma as Adolescents and Young Adults
Bibliographic record
Abstract
Purpose: There is a relative lack of literature documenting late effects in oncology patients treated as adolescents and young adults (AYA) compared to as pediatric patients.The objective of this study was to describe and quantify the incidence of treatmentinduced late effects in AYA patients treated for lymphoma. Materials and Methods:Patients diagnosed with Hodgkin lymphoma (HL) at 15-24 years of age or non-Hodgkin lymphoma (NHL) at 15-29 years of age were identified in the Lymphoid Cancer Database.All patients in the province who received RT as part of their lymphoma management from 1974-2014 with a minimum five-year survival post-RT were included.Late effects were defined as documented health complications persistent or arising beyond five years post-RT.For the analysis of cardiac disease, patients who received mediastinal RT and/or anthracycline chemotherapy were included.For infertility, patients who received pelvic RT and/or chemotherapy agents with the risk of infertility were included.Analyses of all other late effects included only survivors who received RT to the relevant anatomical site.Late effects were analyzed using Kaplan-Meier method and reported as cumulative incidence (CI) ± standard error.Results: Of the 378 patients studied, 226 patients (60%) were diagnosed with HL and 152 patients (40%) with NHL.Median follow-up was 7.2 years (range, 0.2-37).Median age at diagnosis was 22 years.34 patients (9%) were treated with RT only and 344 patients (91%) were treated with RT and chemotherapy.305 patients (81%) received one course of RT and 73 patients (19%) received ≥2 courses.Eighty-five patients (22%) had at least one relapse of lymphoma and 59 patients (16%) were deceased by last follow-up.Of the late effects studied, radiation-induced (RI) hypothyroidism was the most prevalent, with a CI of 19.8±2.5% at five years and 30.4±3.3% at 10 years.The CI of in-field second malignancy was 0.4±0.4% at five years and 1.1±0.8% at 10 years, of which the most common types were skin cancer (n=4) and sarcoma (n=3).The five-year CI of symptomatic RI lung damage was 4.8±1.4% and 10-year CI was 6.8±1.8%.RI esophageal complications occurred at a CI of 1.2±0.7% at five years and 1.9±1% at 10 years.CI of RI xerostomia and/or dental decay was 5.2±1.7% at five years and 7.1±2.1% at 10 years.Treatment-induced cardiac disease occurred at a CI of 1.9±0.8% at five years and 3.7±1.3%at 10 years.CI of reported infertility was 6.9±1.5% at five years and 11.1±2.1% at 10 years.Conclusions: Even with relatively limited follow-up, this study demonstrates that survivors of AYA lymphoma are significantly affected by long-term complications of treatment.The diverse clinical presentation and high incidence of late effects in a young population necessitate focused follow-up and screening when appropriate.Patients and primary care providers need to be informed to ensure proper management.
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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 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".