Risk of thyroid disorders in adult and childhood Hodgkin lymphoma survivors 40 years after treatment

Abstract

Thyroid abnormalities are well reported following childhood treatment for Hodgkin Lymphoma (HL). Limited information exists for adult patients and after modern treatments. We analyzed risks of thyroid disorders in 237 female participants treated at the Royal Marsden Hospital 1970–2015. Multivariable analyses of risk according to treatment and time-related factors, survival analyses, and Cox regression modeling were undertaken. Overall, 33.8% of patients reported thyroid disorders (hypothyroidism 30.0% and thyroid nodules 6.8%). Cumulative prevalence was 42.9% by 40 years follow-up. Risks were greatest after supradiaphragmatic radiotherapy (RR = 5.0, p < 0.001), and increasing dose (RR = 1.03/Gy, p < 0.001). There was no association with a chemotherapy agent. Risks of thyroid disease were as raised following adult as childhood treatment. There was no trend in risk by decade of supradiaphragmatic radiotherapy treatment. Risks of thyroid disease after supradiaphragmatic radiotherapy are as great after adult as childhood treatment and persist after more recent treatment periods.

Keywords:

• Lymphoma and Hodgkin disease
• radiation
• chemotherapeutic approaches

Author contributions

A.M.D. and A.J.S. designed the study. D.C., I.C., E.A., S.I., M.T., and P.C. provided patient information and assisted with data collection and management. A.M.D., M.J., and C.B. undertook data analysis, all authors contributed to completing the final manuscript.

Acknowledgments

We thank Cancer Research UK, the National Institute for Health Research (NIHR) Clinical Research Network research staff, The Royal Marsden Hospital, and the Institute of Cancer Research for support of this Study. Thank you in particular to Jane Lebihan for her work on data administration.

Gratitude is extended to the study participants, the consultants, nurses, and other healthcare providers who have contributed to the study.

This is a summary of independent research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.

Disclosure statement

David Cunningham: Stock and Other Ownership Interests: OVIBIO; Consulting or Advisory Role: OVIBIO; Research Funding: NIHR, AstraZeneca, Roche, Amgen, Celgene, MedImmune, Bayer, 4SC, Clovis Oncology, Eli Lilly, Merck, Leap. Ian Chau: Advisory Board: Eli-Lilly, Bristol Meyers Squibb, MSD, Bayer, Roche, Merck-Serono, Five Prime Therapeutics, Astra-Zeneca, OncXerna, Pierre Fabre, Boehringer Ingelheim, Incyte, Astella; Research funding: Eli-Lilly, Janssen-Cilag Honorarium: Eli-Lilly, Eisai. Sunil Iyengar: Speaker fees: Kite/Gilead, Takeda; Advisory board: Kite/Gilead, Takeda, Beigene; Honoraria: Janssen, Abbvie. All other authors declare no potential competing interests.

Additional information

Funding

This work was funded by Cancer Research UK and The Institute of Cancer Research NIHR Biomedical Research Center. We acknowledge NIHR funding to the Royal Marsden NHS Foundation Trust. M.J. was funded by Breast Cancer Now. The funders had no role in the writing, data collection, analysis, or submission of the article for publication.