Management of Hodgkin lymphoma has progressed over the past 40 years, but that treatment success is bittersweet. Although survivor statistics are encouraging, a new study quantifies the risk of survivors developing second cancers. This is particularly true in people who have relatives with the disease.1

In a multi-institutional investigation utilizing the Swedish Family-Cancer Project Database, researchers studied the records of 9522 patients who had received a diagnosis of primary Hodgkin lymphoma between 1965 and 2012. They also analyzed data from 28,277 first-degree relatives of the survivors. Investigators were from the Institute of Cancer Research in London, United Kingdom, the German Cancer Research Centre in Heidelberg, and the Centre for Primary Health Care Research in Malmö, Sweden. They found that although survivors of Hodgkin lymphoma can now live free of the disease for many years, the increased risk of developing treatment-related complications such as second cancers and cardiovascular disease persists over a long period of time.

Treatment Modifications Unsuccessful

Researchers have suggested a number of factors that may contribute to these sequelae, including the patient’s age and history of smoking, the site and type of treatment, and the chemotherapy or radiotherapy dose the patient received. However, although radiotherapy and chemotherapy regimens have been modified with the goal of reducing treatment-related complications while still achieving treatment success, these changes have not reduced the risk of second cancer in survivors of Hodgkin lymphoma.

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Researchers undertook the current project, “To gain insight into the risk of second cancer after a diagnosis of Hodgkin lymphoma and its relationship to temporal changes in treatment regimens.”1 Mean age of the study participants at the time of Hodgkin lymphoma diagnosis was 49 years. Median follow-up was 12.6 years, although the longest follow-up interval was extended to 48 years. Before the end of the research period, a total of 1215 second cancers occurred in 1121 patients, and 5721 patients had died. The most common second cancer was non-Hodgkin lymphoma, followed by lung cancer, breast cancer, nonmelanoma skin cancers, leukemia, and colorectal cancer.