Survival of U.S. Military Service Members with Hodgkin Lymphoma by Post-9/11 Deployment Status

Classic Hodgkin lymphoma (CHL) commonly affects adolescents and young adults (AYA), including service members (SM). The impact of deployment on CHL outcomes remains unknown. TRICARE beneficiaries diagnosed with CHL from 2001 to 2022 were identified through the Department of War cancer registry. Deployment history came from the Defense Manpower Data Center, and mortality data came from the National Death Index. Mortality was compared between SMs with and without post-9/11 deployment, and associations with deployment-specific variables were evaluated using Cox models adjusted for demographic and clinical factors. An exploratory analysis was performed to assess the survival of AYA SMs by race and to compare mortality with the Surveillance, Epidemiology, and End Results (SEER) database. Among 752 SMs identified, 369 (49%) had deployed after 9/11. Deployment was not associated with overall mortality [adjusted hazard ratio (aHR), 1.64; 95% confidence interval (CI), 0.84-3.19] or disease-specific mortality (aHR, 0.67; 95% CI, 0.13-3.55). No deployment-specific variable meaningfully influenced mortality. There were 21 out of 417 (5%) all-cause deaths in White AYA SMs compared with 0 out of 89 in Black AYA SMs (log-rank test P = 0.0198). Compared with SEER, SMs had lower all-cause mortality (aHR, 0.52; 95% CI, 0.38-0.72) and disease-specific mortality (aHR, 0.29; 95% CI, 0.15-0.59). Post-9/11 deployment did not adversely affect survival among SMs with CHL, highlighting the need for exposure-specific and survivorship-focused research. Survival disparities by race were not appreciated, and mortality in SMs was lower than SEER, highlighting access to care within the Military Health System (MHS) and the healthy soldier effect.

In this national cohort of 752 U.S. SMs with CHL, post-9/11 deployment and deployment-related variables did not adversely affect overall or disease-specific survival. These findings suggest that deployment exposures or occupational demands do not meaningfully alter CHL outcomes. Lower mortality compared with SEER underscores the healthy soldier effect and highlights the advantages of universal access to timely, coordinated cancer care within the MHS.