Will Hodgkin lymphoma treatment affect my heart and lungs?

Question

Hello doctor,

I am 24 years old and was diagnosed three months ago with classical Hodgkin lymphoma, nodular sclerosis type, stage 2A, with bulky mediastinal disease. My first PET scan showed a 4.33-inch mass in my chest and lymph node involvement on both sides above my collarbone.

I recently finished two cycles of ABVD chemotherapy. My interim PET scan had a Deauville score of 4, and my oncologist said this is not the best response. Now, they are considering switching me to BEACOPP. I am worried about this because I have heard BEACOPP can cause more side effects.

After my last round of chemotherapy, my blood counts were low (ANC 0.8, hemoglobin 8.6). I also had a fever for two days, which led to a hospital stay and treatment with intravenous antibiotics.

I am a young woman who has not had children, and I am very worried about my fertility. Before starting treatment, no one talked to me about preserving fertility. When I recently asked about my options, I was told it might be too late since I have already started chemotherapy. I want to know if there are still any ways to preserve my fertility at this point.

I still have a cough and some shortness of breath from the mass in my chest, which has not gone away completely. I am also worried about the radiation therapy I will need soon, since it will target my chest area. Can you tell me what long-term effects this treatment might have on my heart and lungs as a young patient with Hodgkin lymphoma?

Kindly help.

Thank you very much for your guidance and support.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

After two cycles of ABVD (Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine), a Deauville score of 4 indicates some response, though less than expected.

For this reason, your doctors are considering switching to BEACOPP (Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone). While BEACOPP may cause more side effects, it could offer better disease control.

Hodgkin lymphoma is a type of cancer. Its exact cause is not fully understood, though viruses such as Epstein-Barr (a common herpes virus that infects B-cells and is linked to infectious mononucleosis and some cancers, including Hodgkin lymphoma) may contribute. Your symptoms are likely due to the mass in your chest and typically improve with treatment.

Your doctors will likely order another PET-CT (positron emission tomography -computed tomography) scan after adjusting your treatment. Before starting chemotherapy or radiation, they will also monitor your blood levels and assess your heart and lung function.

Options like ovarian suppression or egg or embryo preservation may be offered because fertility is still crucial. To discuss these alternatives, please speak with a reproductive professional as soon as possible.

Other conditions, such as primary mediastinal B-cell lymphoma (it is a type of non-Hodgkin lymphoma that arises from B-cells in the mediastinum (central chest area), non-Hodgkin lymphoma (it is a broad group of blood cancers that originate from lymphocytes and can affect lymph nodes or other organs), thymic tumors (growths arising from the thymus gland in the chest, which can be benign or malignant), or other chest masses, can cause similar symptoms.

However, the most likely diagnosis remains stage II A bulky classical Hodgkin lymphoma (nodular sclerosis type) that has not responded as well as expected.

Depending on your response, your treatment plan may include adding radiation, controlling low white blood cell counts, administering growth factor support if necessary, and transitioning to BEACOPP.

It is crucial to perform routine scans, blood tests, and long-term monitoring to detect adverse effects or relapse. Preventing infections, keeping vaccinations up to date, seeking fertility advice, and maintaining heart health are also important.

Chemotherapy and chest radiation can increase the risk of future heart and lung problems. New treatment strategies aim to reduce these risks while remaining effective. It is crucial to have regular checkups and care that is tailored to you.

I suggest that you talk to your oncologist and, if feasible, a fertility expert about these issues.

I hope this clarifies your concerns.

Please feel free to reach out anytime if you need further assistance.

Thank you.