Cardiovascular and Oncologic Considerations in Adult Hodgkin Lymphoma (JACC: CardioOncology State-of-the-Art Review December 2025)-Article: Cardiovascular and Oncologic Considerations in Adult Hodgkin Lymphoma: JACC: CardioOncology State-of the-Art Review

Article: Cardiovascular and Oncologic Considerations in Adult Hodgkin Lymphoma: JACC: CardioOncology State-of the-Art Review

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This state-of-the-art review in JACC: CardioOncology discusses cardiovascular (CV) and oncologic considerations in adult patients with classic Hodgkin lymphoma (cHL), focusing on balancing curative therapy with minimizing long-term cardiotoxicity.<br /><br />cHL primarily affects younger adults and is highly curable with combination chemotherapy regimens, notably anthracycline-based therapies like ABVD, often with radiation therapy (RT) in select cases. While outcomes are favorable, CV complications—primarily due to anthracyclines and thoracic radiation—constitute a significant cause of morbidity and a leading cause of death in long-term survivors. Older patients and those with pre-existing CV risk are especially vulnerable.<br /><br />The modern treatment approach stratifies patients by disease stage (early I-II vs advanced III-IV), tailoring therapy accordingly. Early-stage favors combined modality treatment (CMT) with ABVD plus RT, though RT is limited in younger patients to reduce CV risks. For advanced disease, novel regimens incorporating brentuximab-vedotin (BV) and immune checkpoint inhibitors (PD-1 inhibitors like nivolumab) are used, improving progression-free survival and reducing toxicities compared to historical regimens.<br /><br />Cardiotoxicity risk is dose-dependent for anthracyclines and RT, with additional risks from immune checkpoint inhibitors primarily related to myocarditis and arrhythmias. Pretreatment cardiac evaluation including echocardiography, and risk stratification based on clinical and treatment factors, is critical. Multidisciplinary care involving oncology and cardiology optimizes treatment decisions.<br /><br />Mitigation strategies include minimizing cumulative anthracycline and radiation doses, using cardioprotectants such as dexrazoxane and statins, optimizing CV risk factors (hypertension, diabetes), and lifestyle interventions like exercise. Cardiac monitoring with echocardiography and biomarkers during and after therapy is recommended, with lifelong surveillance especially for those receiving RT due to long latency of cardiac effects.<br /><br />In relapsed/refractory (R/R) cHL, salvage therapies incorporate immunotherapies and autologous stem cell transplantation (ASCT), with careful CV assessment due to cumulative risks. Cardiovascular events are common post-transplant, requiring ongoing monitoring.<br /><br />The review underscores the importance of individualized, multidisciplinary approaches to preserve cardiac health while maximizing lymphoma cure. Advances in targeted therapies and radiation techniques have improved efficacy and reduced cardiac exposure, but long-term vigilance and prevention remain essential in this young survivor population.

Keywords

classic Hodgkin lymphoma

cardiotoxicity

anthracycline chemotherapy

radiation therapy

cardiovascular complications

brentuximab-vedotin

immune checkpoint inhibitors

cardiac monitoring

multidisciplinary care

autologous stem cell transplantation