Chemotherapy-Induced Valvular Heart Disease.

R adiation therapy has been a mainstay for treating lymphomas and can be curative in some lymphomas such as Hodgkin’s disease. Long term follow-up studies have shown progressive valvular heart disease in some patients, especially those with mediastinal radiation that includes the heart. In addition, these studies have observed that chemotherapy, particularly with anthracyclines, seemed to increase the risk of valvular disease. A study from the Netherlands by Aleman et al. (1) showed that, in 1,474 Hodgkin’s lymphoma 5-year survivors, after a mean follow-up of 19 years compared with the general population in the Netherlands, the incidence of myocardial infarction (hazard ratio [HR]: 3.6) and heart failure (HR: 4.9) were increased significantly. They also noted that the concomitant use of anthracycline chemotherapy in 29% increased the incidence of heart failure and valvular disease, but did not report on the use of anthracycline chemotherapy alone. A Norwegian study that started in 1993 and was updated in 2009 studied 116 Hodgkin’s lymphoma survivors at a mean of 10 years after radiation therapy and in some anthracycline therapy, and showed that 31% had moderate valve regurgitation (2). The subsequent follow-up of 51 of these patients at a mean follow-up of 22 years showed progressive valvular heart disease (3). In 33% of the patients with moderate regurgitation at the first study, progression to severe regurgitation or valve replacement had occurred. Also, 39% of these patients now exhibited aortic stenosis, some severe, that had not been