Late effects of treatment for Hodgkin lymphoma

With advances in multimodality therapy, survival from Hodgkin lymphoma (HL) now exceeds 80%, resulting in a large cohort of survivors who are at risk for adverse long-term sequelae of therapy. This risk is complicated by possible endogenous predispositions to developing late effects, which relate to the patient's underlying susceptibility to HL. Finally, the impact of HL on the host can compromise organ function. This article reviews the possible dominant late effects for survivors of HL and strategies for monitoring and screening. As therapy for HL has changed and evolved, so has the spectrum of late effects. Mortality from HL has decreased, whereas delayed effects of therapy have increased. Refinements in therapy to decrease toxicity have occurred in response to the success in curing HL. Thus, modifications in therapeutic protocols using a risk-adapted strategy have reduced the use of alkylating agents, anthracyclines, and radiotherapy, which are associated with adverse long-term sequelae. The most clinically evident sequelae are those involving the endocrine and cardiovascular systems, and the most morbid are hematologic and solid second malignancies. Primary and secondary prevention strategies can be developed as knowledge of delayed effects of therapy increases.