{"entity":{"id":"lymphoma-tx-hodgkin-late-effects","kind":"term","name":"Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them","aka":["Second cancers after Hodgkin lymphoma","Cardiac late effects","Breast screening after chest radiotherapy","Survivorship Hodgkin"],"tldr":"Hodgkin lymphoma is usually cured, and the problems that follow arrive twenty and thirty years later: heart disease, an underactive thyroid, and second cancers, especially breast cancer in women irradiated to the chest when young. Most of them can be watched for.","summary":"What the treatments cost. Anthracyclines cause dose-dependent cardiomyopathy. Mediastinal radiotherapy causes coronary artery disease, valve disease and, decades later, breast and lung cancer in the irradiated field; neck radiotherapy causes hypothyroidism in a large minority and carotid disease. Alkylating agents, especially procarbazine in escalated BEACOPP, cause infertility and a small excess of myelodysplasia and acute myeloid leukaemia. Bleomycin causes lung fibrosis, which is why RATHL removed it from later cycles in PET-negative patients. Splenectomy and splenic irradiation, historic now, cause lifelong sepsis risk.\n\nThe long-term series in the corpus makes the point about competing causes: among 471 patients with nodular lymphocyte-predominant Hodgkin lymphoma followed by the German Hodgkin Study Group, ten-year overall survival was 92.1 per cent, second cancers occurred in 10.2 per cent, and of 43 deaths only 10 were from the lymphoma against 20 from second cancers and 13 from conditions possibly related to treatment.\n\nWhat follow-up should include. Annual blood pressure, lipids and diabetes screening; thyroid function yearly after neck or upper mediastinal radiotherapy; echocardiography at intervals after anthracyclines or mediastinal radiotherapy; smoking cessation support, because the lung cancer risk after chest radiotherapy multiplies with smoking rather than adding to it; and, in England, entry to the NHS breast screening programme's very high risk pathway for women who received radiotherapy to breast tissue during treatment for Hodgkin or non-Hodgkin lymphoma between the ages of 10 and under 36, who are identified from cancer registries and radiotherapy records by the breast screening after radiotherapy dataset and referred automatically. Vaccination and prompt treatment of infection after splenectomy.\n\nThis is also the reason treatment has changed. Smaller fields, lower doses, PET-adapted omission of radiotherapy, removal of bleomycin and the replacement of procarbazine in BrECADD are all attempts to keep the cure and lose the twenty-year bill.","asOf":"2026-09-29","links":[{"label":"NCI PDQ: adult Hodgkin lymphoma treatment (health professional)","url":"https://www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq"},{"label":"NHS breast screening programme: protocols for surveillance of women at higher risk of developing breast cancer (GOV.UK)","url":"https://www.gov.uk/government/publications/breast-screening-higher-risk-women-surveillance-protocols/protocols-for-surveillance-of-women-at-higher-risk-of-developing-breast-cancer"}],"tags":[],"related":[],"cancers":["hodgkin-lymphoma","early-stage-classical-hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma","nodular-lymphocyte-predominant-hodgkin-lymphoma"],"sections":[],"technologies":["imrt-igrt","proton-therapy","survivorship-care-plan","strain-echocardiography-gls"],"targets":[],"drugs":["doxorubicin","bleomycin","procarbazine","dacarbazine","vinblastine"],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects","secondary-malignancy","cardiotoxicity","lymphoma-tx-fertility-preservation"],"trials":["rathl","hd21"],"people":[],"bottlenecks":[],"keyPapers":["paper-eichenauer-nlphl-ghsg-hd7-hd15-long-term-jco-2020"],"journals":[],"dependsOn":[],"notes":[],"category":"Side effects"},"route":"/terms/lymphoma-tx-hodgkin-late-effects/","neighbours":{"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"}],"technology":[{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"proton-therapy","kind":"technology","name":"Proton therapy","route":"/technologies/proton-therapy/"},{"id":"strain-echocardiography-gls","kind":"technology","name":"Strain echocardiography (global longitudinal strain)","route":"/technologies/strain-echocardiography-gls/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"dacarbazine","kind":"drug","name":"Dacarbazine","route":"/drugs/dacarbazine/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"procarbazine","kind":"drug","name":"Procarbazine","route":"/drugs/procarbazine/"},{"id":"vinblastine","kind":"drug","name":"Vinblastine","route":"/drugs/vinblastine/"}],"term":[{"id":"cardiotoxicity","kind":"term","name":"Cardiotoxicity (LVEF decline, cardiomyopathy)","route":"/terms/cardiotoxicity/"},{"id":"lymphoma-tx-fertility-preservation","kind":"term","name":"Fertility before lymphoma treatment: what to ask for, and when","route":"/terms/lymphoma-tx-fertility-preservation/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"secondary-malignancy","kind":"term","name":"Secondary malignancy (therapy-related cancer)","route":"/terms/secondary-malignancy/"}],"trial":[{"id":"hd21","kind":"trial","name":"GHSG HD21","route":"/trials/hd21/"},{"id":"rathl","kind":"trial","name":"RATHL","route":"/trials/rathl/"}],"paper":[{"id":"paper-eichenauer-nlphl-ghsg-hd7-hd15-long-term-jco-2020","kind":"paper","name":"Long-term follow-up of nodular lymphocyte-predominant Hodgkin lymphoma treated in the GHSG HD7 to HD15 trials","route":"/key-papers/paper-eichenauer-nlphl-ghsg-hd7-hd15-long-term-jco-2020/"}]}}