Treatments affecting splenic function as a risk factor for valvular heart disease in Childhood Cancer Survivors: A DCCSS-LATER study

Bente M. Houtman*, Iris Walraven, Livia Kapusta, Arco J. Teske, Eline van Dulmen-den Broeder, Wim J. E. Tissing, Marry M. van den Heuvel-Eibrink, A. B. Birgitta Versluys, Dorine Bresters, Margriet van der Heiden-vander Loo, Cecile Ronckers, Wouter E. M. Kok, Helena J. H. van der Pal, Saskia M. F. Pluijm, Geert O. Janssens, Nicole M. A. Blijlevens, Leontien C. M. Kremer, Jacqueline J. Loonen, E. A. M. Lieke Feijen

*Corresponding author for this work

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Abstract

PurposeSplenectomy might be a risk factor for valvular heart disease (VHD) in adult Hodgkin lymphoma survivors. As this risk is still unclear for childhood cancer survivors (CCS), the aim of this study is to evaluate the association between treatments affecting splenic function (splenectomy and radiotherapy involving the spleen) and VHD in CCS.MethodsCCS were enrolled from the DCCSS-LATER cohort, consisting of 6,165 five-year CCS diagnosed between 1963 and 2002. Symptomatic VHD, defined as symptoms combined with a diagnostic test indicating VHD, was assessed from questionnaires and validated using medical records. Differences in the cumulative incidence of VHD between CCS who received treatments affecting splenic function and CCS who did not were assessed using the Gray test. Risk factors were analyzed in a multivariable Cox proportional hazards model.ResultsThe study population consisted of 5,286 CCS, with a median follow-up of 22 years (5-50 years), of whom 59 (1.1%) had a splenectomy and 489 (9.2%) radiotherapy involving the spleen. VHD was present in 21 CCS (0.4%). The cumulative incidence of VHD at the age of 40 years was significantly higher in CCS who received treatments affecting splenic function (2.7%, 95% confidence interval (CI) 0.4%-4.9%) compared with CCS without (0.4%, 95% CI 0.1%-0.7%) (Gray's test, p = 0.003). Splenectomy was significantly associated with VHD in a multivariable analysis (hazard ratio 8.6, 95% CI 3.1-24.1).Conclusions and implicationsSplenectomy was associated with VHD. Future research is needed to determine if CCS who had a splenectomy as part of cancer treatment might benefit from screening for VHD.
Original languageEnglish
Article numbere31251
Number of pages12
JournalPediatric Blood & Cancer
Volume71
Issue number11
DOIs
Publication statusE-pub ahead of print - 12 Aug 2024

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Publisher Copyright:
© 2024 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.

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