Late effects of treatment in Hodgkin lymphoma

This article summarized some of the possible late effects of Hodgkin lymphoma treatment.

The standard treatment options for Hodgkin lymphoma are radiation and chemotherapy. These treatments have led to very high remission rates (no sign of disease) in many patients. Radiation and chemotherapy have also been associated with many side effects, including some that occur many years after treatment. It is essential to understand what those effects may be, so that patients can undergo proper surveillance.

This article summarized the long-term effects of radiation and chemotherapy for patients with Hodgkin lymphoma.

Both radiation and chemotherapy have been associated with an increased risk of second cancers. Chemotherapy has been associated with the risk of leukemia. Radiation has been associated with risk of solid tumors. Studies have found that the risk of solid tumors (like lung or breast cancers) does not rise significantly until 5 to 20 years after treatment. The risk of solid tumors was highest for those who were treated at a younger age.

Higher radiation doses are associated with increasing risk of second cancers. Smoking also adds to the risk of developing lung cancer.

Radiation to the chest area has been associated with an increased risk of cardiovascular disease. Certain chemotherapies (anthracyclines, such as doxorubicin) can also increase the risk. Multiple studies have found a 2– to 7-fold increase in the risk of cardiac death, such as due to heart attack. The risk is greater for patients who had radiation therapy at a younger age. The risk increases with increasing radiation dose. Another study found this increased risk lasts for up to 35 years.

Risk factors for cardiovascular disease, such as high blood pressure or diabetes, also increase risk in Hodgkin lymphoma survivors. Regular exercise was associated with a decrease in risk.

Chemotherapy and radiation to the testes or ovaries can both affect fertility (the ability to conceive a child). In women, the risk of infertility following radiation rises with age. In men, doses of radiation of 1.2 Gy are associated with fertility problems. The chemotherapy combination escalated BEACOPP is associated with infertility in 90% of all men and 50% of women over 30.

Other late effects associated with Hodgkin lymphoma treatments include decreased lung function, thyroid disease, and fatigue.

This study determined that there are many late effects associated with Hodgkin lymphoma treatments. The authors suggest that survivors should undergo regular screening for cancers, cardiovascular disease, and thyroid disorders. Screening should depend on what areas received radiation.