Awareness of the increased risk for developing subsequent malignancies remains of great importance for survivors of Hodgkin’s lymphoma and for their physicians, according to a study published in The New England Journal of Medicine.1

Although it is known that Hodgkin’s lymphoma survivors are at an increased risk for treatment-related subsequent malignant neoplasms, there is limited evidence on the effect of less toxic treatments, particularly those introduced in the late 1980s, on the long-term risk of a second malignancy. Therefore, researchers sought to compare the risk of a second cancer among these patients with the expected cancer risk in the general population.

For the study, researchers in the Netherlands enrolled 3905 patients who had received treatment for Hodgkin’s lymphoma between 1965 and 2000 and were 15 to 50 years of age at the time of treatment. Patients were included if they had survived for at least 5 years after the initiation of cancer therapy.

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Results showed that at a median follow-up of 19.1 years, 908 patients were diagnosed with a total of 1055 second cancers, resulting in a standardized incidence ratio (SIR) of 4.6 (95% CI, 4.3 – 4.9) in the Hodgkin’s lymphoma survivors compared with the general population. Researchers found that there was still an elevated risk of second malignant neoplasm 35 years or more after treatment (SIR, 3.9; 95% CI, 2.8 – 5.4).

The study demonstrated a cumulative incidence of a second cancer among Hodgkin’s lymphoma survivors of 48.5% (95% CI, 45.4 – 51.5) at 40 years. There was no difference in the cumulative incidence of second solid cancers between 1965 to 1976, 1977 to 1988, or 1989 to 2000 (P = .71).

In regard to specific chemotherapy, researchers found that a cumulative procarbazine dose of 4.3 g/m2 or more was associated with a significantly lower risk for breast cancer (HR, 0.57; 95% CI, 0.39 – 0.84) but a higher risk for gastrointestinal cancer (HR, 2.70; 95% CI, 1.69 – 4.30).

The findings suggest that the risk of second solid cancers did not appear to be lower among patients treated between 1989 and 2000 than among survivors treated in earlier periods.


  1. Schaapveld M, Aleman BMP, van Eggermond AM, et al. Second cancer risk up to 40 years after treatment for Hodgkin’s lymphoma. N Engl J Med. 2015; 373(26):2499-2511.