Low incidence of long-term respiratory impairment in Hodgkin lymphoma survivors

Introduction of new chemotherapy regimens over the last decade resulted in 90% survival in patients with Hodgkin lymphoma (HL), which enhances significance of abrogating chemotherapy-related long-term toxicities in young subjects. The present trial evaluated incidence of long-term respiratory complications associated with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or bleomycin sulfate, etoposide phosphate, doxorubicin hydrochloride (Adriamycin), cyclophosphamide, vincristine sulfate (Oncovin), procarbazine hydrochloride, and prednisone (BEACOPP). Sixty-seven HL patients, 21 treated with ABVD and 46 with BEACOPP, underwent prospective respiratory evaluation. Median follow-up from chemotherapy completion to respiratory assessment was 61 months. Abnormal lung function tests (LFT) were found in nine patients (13.6%)—three with functional dyspnea and six asymptomatic—with reduced DLCO (≤70%), VC, and TLC. Previous history of bleomycin pulmonary toxicity was found to be the only statistically significant factor for chronic respiratory impairment (75% vs. 10%, p = 0.007, relative risk (RR) = 28; 95% CI, 2.5–313). However, abnormal LFT tended to occur more frequently in patients receiving mantle field irradiation (18% vs. 9%, RR = 2.2), those who experienced respiratory infection (25% vs. 13%, RR = 2.25), and patients treated with ABVD compared to BEACOPP (19% vs. 11%, RR = 1.9). Long-term respiratory impairment in HL survivors is unusual and rarely results in functional discomfort. BEACOPP is “respiratory safe,” being associated with a nonsignificant risk for long-term respiratory dysfunction.