Hodgkin’s Disease: Complications

The following are the most important diseases or complications that may be contributed to by Hodgkin’s disease:

Respiratory system (J00-J99)

  • Pulmonary disease secondary to radiation and/or chemotherapy.

Blood, blood-forming organs – immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Hypercalcemia (calcium excess) due to tumor hypercalcemia (tumor-induced hypercalcemia, TIH).
  • Hyperthyroidism* (hyperthyroidism) (recommendation grade A).
  • Hypothyroidism* (hypothyroidism) (recommendation grade A).
  • Climacterium praecox (premature menopause; premature menopause).

Circulatory system (I00-I99)

  • Cardiac disease resulting from radiation and/or chemotherapy: coronary artery disease (CAD; coronary artery disease), heart failure (cardiac insufficiency), and valvular dysfunction.
  • Superior vena cava syndrome (VCSS) – symptom complex resulting from venous outflow obstruction of the superior vena cava (VCS; superior vena cava); usually caused by mediastinal lymphoma leading to compression of the superior vena cava; clinical presentation:
    • Congested and dilated veins of the neck (jugular venous congestion), head and arms.
    • Feeling of pressure in the head or neck
    • Cephalgia (headache)
    • Other symptoms depending on the cause: dyspnea (shortness of breath), dysphagia (difficulty swallowing), stridor (whistling breathing sound that occurs during inhalation and/or exhalation), cough, cyanosis (bluish discoloration of the skin and mucous membranes).

Infectious and parasitic diseases (A00-B99).

  • Infectious diseases of all kinds

Neoplasms – tumor diseases (C00-D48)

  • Mammary carcinoma (breast cancer), in women treated by radiotherapy (radiotherapy) before the age of 30.
  • Recurrence – recurrence of the disease.
  • Therapy-induced secondary neoplasms; lifetime risk at least 4.6-fold higher than in general population: thyroid, female mammary (40%), lung 20%), and lymphoid tissues (leukemia; 5%)
  • Paraneoplastic cerebellar degeneration (PZD) – characterized by symptoms such as ataxia (disorders of movement), dysarthria (disorders of speech) and nystagmus (jerky rhythmic on both eyeballs same-sense rapid movement of the eyeballs).

Psyche – Nervous System (F00-F99; G00-G99).

  • Fatigue (= tumor-associated fatigue; English “cancer-related fatigue“, CRF) – sometimes occurring years after treatment, which is more than 80% successful; severe fatigue are significantly less likely to be in education or employment 5 years after treatment.
  • Polyneuropathy – generic term for diseases of the peripheral nervous system associated with chronic disorders of peripheral nerves or parts of nerves (wg, chemotherapy; here: vinca alkaloids).
  • Other CNS manifestations, unspecified.

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include: Proteinuria (increased excretion of protein in urine) with protein loss greater than 1 g/m²/body surface area per day; hypoproteinemia, peripheral edema (water retention) due to serum hypalbuminemia of < 2.5 g/dL, hyperlipoproteinemia (dyslipidemia).

Further

  • Radiation and/or chemotherapy sequelae such as:
    • Cardiovascular damage* (recommendation grade A).
    • Pulmonary disease* (recommendation grade B).

* The given recommendation grade refers to follow-up because of increased risk of morbidity (because of organ toxicities of chemotherapy or possible direct radiation damage). Screening should occur approximately 8 years after primary therapy.

Prognostic Factors

  • Large mediastinal tumor occupying more than one-third of the thoracic diameter
  • Extranodal involvement
  • Infestation of ≥ 3 lymph node areas.
  • High ESR (erythrocyte sedimentation rate)

Risk factors for survival after stem cell transplantation (SCT):

  • Hodgkin stage IV
  • Relapse within three months
  • ECOG performance status of at least 1
  • Tumor mass ≥ 5 cm and nonresponse to salvage chemotherapy (detected by functional imaging rather than conventional CT scans).

These five risk factors are appropriate for determining a risk score (see below). Other prognostic factors:

  • Vitamin D deficiency before treatment of the disease:
    • Patients with progression or relapse (recurrence) had significantly lower vitamin D levels than patients without relapse (21.4 versus 35.5 nmol/l); these patients were also more likely to have vitamin D deficiency (68 versus 41%, P <0.0001)
    • Progression-free survival at 10 years: 81.8% of patients without vitamin D deficiency versus 64, 2% of patients with vitamin D deficiency