Materazzo Carlo, Massimino Maura, Schiavello Elisabetta, Podda Marta, Gandola Lorenza, Cefalo Graziella, Catania Serena, Meazza Cristina, Moschetti Ivan, Terenziani Monica
Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Tumori. 2017 Nov 23;103(6):566-571. doi: 10.5301/tj.5000670. Epub 2017 Jul 8.
Cardiac late effects are responsible for a significant burden of mortality and morbidity among pediatric Hodgkin's lymphoma (HL) survivors (HLS). The aim of our study was to assess clinical and subclinical cardiac sequelae in a cohort of childhood HLS treated in the 1980s with doxorubicin, bleomycin, vinblastine, and dacarbazine (the ABVD regimen) and limited-field radiotherapy (RT).
We retrospectively examined a series of HLS treated from 1979 to 1989. We searched for subtle cardiac abnormalities in a subgroup of asymptomatic individuals, who underwent rest and exercise echocardiography at least 20 years after completing their therapies. Their cardiac assessment included physical examination, electrocardiogram (ECG), and resting and postexercise echocardiograms.
On thorough cardiac assessment a mean of 21 years after their diagnosis, none of the 53 unselected asymptomatic HLS showed physical signs or significant ECG abnormalities during or after the stress echo test. Twenty-two (41%) of the 53 patients revealed valvular abnormalities, with mitral regurgitation in 28%, aortic regurgitation in 9%, and both in 4%. No significant myocardial dysfunction as a result of previous combined doxorubicin treatment and chest RT was identified. Only 2 individuals had mild pericardial alterations.
The present study shows that long-term cardiac effects are common in HLS treated with the ABVD regimen and RT. The most frequent complications observed in this sample were essentially coronary artery disease and valvular abnormalities. None of the survivors in this sample showed overt congestive heart failure, a finding in contrast with larger studies.
心脏晚期效应是导致儿童霍奇金淋巴瘤（HL）幸存者（HLS）出现显著死亡和发病负担的原因。我们研究的目的是评估一组在20世纪80年代接受多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD方案）以及局限性野放射治疗（RT）的儿童HLS的临床和亚临床心脏后遗症。
我们回顾性研究了1979年至1989年接受治疗的一系列HLS。我们在一组无症状个体的亚组中寻找细微的心脏异常，这些个体在完成治疗至少20年后接受了静息和运动超声心动图检查。他们的心脏评估包括体格检查、心电图（ECG）以及静息和运动后超声心动图。
在诊断后平均21年进行全面心脏评估时，53名未经挑选的无症状HLS在负荷超声心动图检查期间或之后均未出现体征或显著的ECG异常。53名患者中有22名（41%）显示瓣膜异常，其中二尖瓣反流占28%，主动脉瓣反流占9%，两者均有的占4%。未发现先前联合多柔比星治疗和胸部放疗导致的显著心肌功能障碍。只有2名个体有轻度心包改变。
本研究表明，接受ABVD方案和RT治疗的HLS中，长期心脏效应很常见。该样本中观察到的最常见并发症主要是冠状动脉疾病和瓣膜异常。该样本中的幸存者均未出现明显的充血性心力衰竭，这一发现与更大规模的研究结果相反。
