Treatment with anthracyclines increases the risk for developing heart failure by 3-fold independently of radiation dose among survivors of Hodgkin lymphoma, according to a study published in the Blood.1

Previous research established that Hodgkin lymphoma survivors treated with radiation treatment and/or chemotherapy have increased risks of heart failure, though it was unknown whether a radiation dose-response relationship exists.

To assess the impact of radiotherapy dose and anthracycline therapy on heart failure risk in this population, researchers analyzed data from 2617 5-year survivors of Hodgkin lymphoma diagnosed before age 51 years, of whom 91 had moderate or severe heart failure as their first cardiovascular diagnosis.

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The average mean left ventricular dose (MLVD) was 16.7 Gy for cases and 13.8 Gy for controls (P = .003). Investigators found no statistically significant association between MLVD and heart failure rates, but there were trends toward an association between increasing MLVDs and increasing risks of heart failure.

Treatment with anthracycline-containing chemotherapy was associated with nearly a 3-fold higher risk of heart failure (odds ratio, 2.83; 95% CI, 1.43-5.59) irrespective of MLVD (Pinteraction = .09).

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Among patients treated with anthracycline-containing chemotherapy, the 25-year cumulative risks of heart failure following MLVDs of 0 to 15 Gy, 16 to 20 Gy, and 21 Gy or higher were 11.2%, 15.9% and 32.9%, respectively. The same rates were 4.4%, 6.2% and 13.3%, respectively, for patients who did not receive anthracyclines.


  1. van Nimwegen FA, Ntentas G, Darby SC, et al. Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines. Blood. 2017 Jan 31. doi: 10.1182/blood-2016-09-740332 [Epub ahead of print]