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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.
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.
The 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.
What 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.
This 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.
Showing the molecule this term concerns: Doxorubicin.
Shares Secondary malignancy (therapy-related cancer), Fertility before lymphoma treatment: what to ask for, and when, Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Bleomycin.
Shares Procarbazine, Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Dacarbazine, Bleomycin.
Shares RATHL, Dacarbazine, Vinblastine, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares RATHL, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares RATHL, GHSG HD21, Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares RATHL, GHSG HD21, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma.
Shares Dacarbazine, Vinblastine, Early-stage classical Hodgkin lymphoma (stage I to II), Doxorubicin.
Shares Dacarbazine, Vinblastine, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Doxorubicin.