# Identifying clustering in patterns of late effects among survivors of adolescent and young adult Hodgkin lymphoma

## TL;DR

This study identifies patterns of long-term health issues in young adult Hodgkin lymphoma survivors and finds that certain groups face higher risks based on insurance and treatment.

## Contribution

The study introduces a clustering approach to identify distinct patterns of late effects in adolescent and young adult Hodgkin lymphoma survivors.

## Key findings

- Four distinct late effects clusters were identified among survivors, including a low morbidity group and groups with high probabilities of thyroid disorders, cardiovascular disease, and multiple conditions.
- Publicly insured survivors were more likely to be in clusters with higher morbidity compared to those with private insurance.
- Intensive treatments like radiation and hematopoietic cell transplantation were strongly associated with higher risk clusters.

## Abstract

We examined late effects clustering among adolescent and young adult (AYA; age 15-39 years at diagnosis) Hodgkin lymphoma (HL) survivors and identified characteristics associated with each cluster.

We included AYAs with HL in 2006-2018 from the California and Utah Cancer Registries linked to statewide hospitalization, emergency department, and ambulatory surgery visit data. We identified severe late effects >2 years after cancer diagnosis in 9 late effects categories. Latent class analysis (LCA) was used to identify late effects clusters. Multinomial logistic regression models estimated adjusted associations of demographic and treatment characteristics with LCA late effect group.

We identified 4635 AYA HL survivors with median follow-up of 8.2 years and 4 late effects groups: 77.1% had a low probability of any late effect (Low Morbidity), 12.8% had high probability of Thyroid disorders, 8.0% had high probability of Cardiovascular Disease (CVD), and 2.1% had high probability of Multiple Conditions (CVD, diabetes/pancreatic, thyroid, and renal diseases). Publicly insured AYAs were more likely than those with private insurance to be in the CVD (OR = 1.53, 95% CI = 1.18 to 1.98) and Multiple Conditions (OR = 2.17, 95% CI = 1.29 to 3.66) than the Low Morbidity group. AYAs with radiation were more likely to be in the Multiple Conditions (OR = 2.31, 95% CI = 1.41 to 3.78) and Thyroid (OR = 2.81, 95% CI = 2.20 to 3.58) groups. Hematopoietic cell transplantation was associated with Multiple Conditions (OR = 9.50, 95% CI = 5.82 to 15.50), CVD (OR = 3.82, 95% CI = 2.96 to 4.93), and Thyroid (OR = 2.86, 95% CI = 2.12 to 3.85) groups.

While most AYA HL survivors were in the Low Morbidity group, those with public insurance or intense treatment may be at higher risk for multiple conditions.