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Spätschäden und Survivorship nach Behandlung des Hodgkin-Lymphoms

Late sequelae and survivorship following treatment of Hodgkin’s lymphoma

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Im Hinblick auf die eindrucksvollen Remissionsraten, die in den letzten Jahren in der Therapie des Hodgkin-Lymphoms (HL) erzielt wurden, gewinnen die therapieinduzierten Spätkomplikationen einen immer größeren Stellenwert.

Ergebnisse

Zu der wichtigsten therapieinduzierten Komplikation zählt die Entwicklung von Zweitneoplasien, die ein wesentliches Mortalitätsrisiko für Langzeitüberlebende eines HL darstellt. Die Organtoxizitäten umfassen kardiale, pulmonale und gonadale Schäden. Letztere sind besonders für junge Survivor mit noch nicht abgeschlossener Familienplanung relevant. Vor Einleitung der Therapie soll über die Möglichkeit fertilitätserhaltender Maßnahmen aufgeklärt werden. Auch die allgemeine Lebensqualität von HL-Patienten ist langfristig niedriger als die von nichterkrankten gleichaltrigen Menschen. Führendes Problem hierbei ist die Entwicklung von Fatigue, die häufig ein langfristiges Problem darstellt.

Diskussion

Die Therapiestrategien aktueller klinischer Studien zielen auf eine Reduktion von therapiebedingen Spätschäden bei gleichzeitiger Beibehaltung der guten Tumorkontrolle.

Abstract

Background

As a consequence of the impressive long-term remission rates in Hodgkin’s lymphoma (HL) patients, current clinical research focuses on the reduction of treatment-related delayed complications. Thus, carefully conducted analyses of treatment-related sequelae which can occur during the survivorship period are needed.

Results

The most important treatment-related complication is the development of secondary neoplasms, which represent a significant risk of mortality in long-term HL survivors. Organ toxicities comprise cardiac, pulmonary and gonadal dysfunction, of which the latter is particularly important in young survivors with a desire to have children. At diagnosis, physicians should thoroughly inform the patient and consider protective methods to preserve fertility. Furthermore, the quality of life in HL survivors is lower than in controls of the same age. Most survivors suffer from cancer-related fatigue, which can persist a long time after primary treatment.

Discussion

The therapeutic strategies of most recent clinical trials in HL aim at reducing therapy-related late sequelae with a simultaneous retention of good tumor control.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Behringer, T.V. Halbsguth und P. Borchmann geben an, dass kein Interessenkonflikt besteht. Alle im Manuskript beschriebenen Untersuchungen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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  1. Klinik I für Innere Medizin, Studienzentrale der GHSG, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    K. Behringer, T.V. Halbsguth & P. Borchmann

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  1. K. Behringer
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  2. T.V. Halbsguth
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  3. P. Borchmann
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Correspondence to K. Behringer.

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Behringer, K., Halbsguth, T. & Borchmann, P. Spätschäden und Survivorship nach Behandlung des Hodgkin-Lymphoms. Onkologe 20, 470–476 (2014). https://doi.org/10.1007/s00761-013-2638-2

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