Late Effects of Treatment

Patients treated for Hodgkin lymphoma have an increased risk of developing other diseases or conditions later in life because both chemotherapy and radiation therapy can cause permanent damage. Treatments have improved in the last 30 years, and now patients are less likely to experience late effects, but there is still some risk. Therefore, it is important that patients stay current with their follow-up care to monitor any developments.

• Some survivors of Hodgkin lymphoma have a higher risk of developing a secondary cancer, especially acute myelomonocytic leukemia (following certain types of chemotherapy), non-Hodgkin lymphoma, lung cancer, or breast cancer. The risk of a secondary cancer is likely to be lower in the future because the types of therapy now used have fewer risks. Patients can lower their risk of secondary cancers by eliminating other risk factors, such as smoking.
  
  
• Radiation therapy to the chest area can cause lung damage, increase the risk of heart disease, and increase the risk of lung and breast cancer. It is important that men and women who received radiation to the chest limit other risk factors that may lead to heart damage, such as smoking, obesity, and high cholesterol. It is important that women who received radiation therapy to the chest begin regular breast cancer screening at an early age.
  
  
• Patients who received anthracyclines (doxorubicin) or bleomycin during chemotherapy have a higher risk of heart damage and lung damage, respectively.
  
  
• Radiation therapy to the neck or chest area (specifically, or as part of total body irradiation [TBI] during a stem cell transplantation) can cause thyroid dysfunction, including hypothyroidism. Hypothyroidism is when a body produces too little thyroid hormone, which regulates metabolism.
  
  
• Radiation therapy to the pelvic area can lead to infertility (inability to bear children) in men or women. Also, teenagers and adults who received chemotherapy may be at higher risk for low sperm counts (for men) or damage to the ovaries (for women). Men who received combination chemotherapy may be at risk for sterility after treatment. The risk appears to be associated with drugs known as alkylating agents, which are used much less in current chemotherapy for Hodgkin lymphoma. Although the risk of infertility for men is low after chemotherapy for Hodgkin lymphoma, it is still possible, and men who are considering having a family should consider sperm storage prior to starting chemotherapy. Men who undergo stem cell transplantation are almost always sterile after this treatment. Women who received chemotherapy for Hodgkin lymphoma have an increased risk of infertility or early menopause. Again, this is mostly related to alkylating agents and is less common with modern chemotherapy treatments. It is unusual, but not impossible, for women to become pregnant after stem cell transplantation.
  
  
• Survivors of Hodgkin lymphoma may also have a higher risk of depression or other psychologic problems. Learn more about the importance of follow-up care in the After Treatment section.

The risks of secondary cancers are likely to be lower in the future because the types of therapy now used carry fewer risks.