TriangleHEALTH PROFESSIONAL · SOURCE READING
Late Effects From Childhood and Adolescent Hodgkin Lymphoma Therapy
Source: Childhood Hodgkin Lymphoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 16, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary.
Childhood and adolescent survivors of Hodgkin lymphoma may be at risk of developing numerous late complications of treatment related to radiation, specific chemotherapeutic exposures, and surgical staging.[1,2] Adverse treatment effects may impact the following:
Reproductive system (male gonadal toxicity and female gonadal toxicity).
Source links and citations
Endocrine system (thyroid abnormalities).
Source links and citations
Cardiovascular system.
Source links and citations
Risk of subsequent benign or malignant neoplasms.
Source links and citations
Oral/dental health.
Pulmonary function.
Musculoskeletal growth and development.
Immune system.
In the past 30 to 40 years, pediatric Hodgkin lymphoma therapy has changed dramatically to limit exposure to radiation and chemotherapeutic agents, such as anthracyclines, alkylating agents, and bleomycin. When counseling individual patients about the risk of specific treatment complications, the era of treatment should be considered.
In this regard, Childhood Cancer Survivor Study (CCSS) investigators determined the incidence of serious health conditions among 2,996 five-year survivors of pediatric Hodgkin lymphoma (mean age, 35.8 years), compared outcomes by treatment era and strategies, and estimated risks associated with contemporary therapy.[3]
Source links and citations
The cumulative incidence of any grade 3 to 5 conditions by age 35 years was 31.4%. Females were twice as likely as males to experience these conditions (hazard ratio, 2.1).
The decade-specific risk of grade 3 to 5 conditions declined by 20% from the 1970s to the 1990s (P trend = .002).
Compared with survivors who were treated with chest radiation therapy of 35 Gy or higher in combination with an anthracycline or alkylating agent, patients who received contemporary regimens for low- or intermediate-risk disease had an estimated 40% reduction in risk of grade 3 to 5 conditions (HR, 0.6).
The risk of grade 3 to 5 conditions in survivors who had a recurrence or underwent hematopoietic stem cell transplant (HSCT) was substantially elevated and similar to that of survivors treated with high-dose, extended-field radiation therapy.
Table 11 summarizes late health effects observed in Hodgkin lymphoma survivors, followed by a limited discussion of common late effects. For a full discussion of this topic, see Late Effects of Treatment for Childhood Cancer.
Source links and citations
| Health Effects | Predisposing Therapy | Clinical Manifestations |
|---|---|---|
| Reproductive | Alkylating agent chemotherapy | Hypogonadism |
| Gonadal irradiation | Infertility | |
| Thyroid | Radiation impacting thyroid gland | Hypothyroidism |
| Hyperthyroidism | ||
| Thyroid nodules | ||
| Cardiovascular | Radiation impacting cardiovascular structures | Subclinical left ventricular dysfunction |
| Cardiomyopathy | ||
| Pericarditis | ||
| Heart valve dysfunction | ||
| Conduction disorder | ||
| Coronary, carotid, subclavian vascular disease | ||
| Myocardial infarction | ||
| Stroke | ||
| Anthracycline chemotherapy | Subclinical left ventricular dysfunction | |
| Cardiomyopathy | ||
| Congestive heart failure | ||
| Subsequent neoplasms or disease | Alkylating agent chemotherapy | Myelodysplasia/acute myeloid leukemia |
| Epipodophyllotoxins | Myelodysplasia/acute myeloid leukemia | |
| Radiation | Solid benign and malignant neoplasms | |
| Anthracycline chemotherapy | Breast cancer | |
| Oral or dental | Any chemotherapy in a patient who has not developed permanent dentition | Dental maldevelopment (tooth or root agenesis, microdontia, root thinning and shortening, enamel dysplasia) |
| Radiation impacting oral cavity and salivary glands | Salivary gland dysfunction | |
| Xerostomia | ||
| Accelerated dental decay | ||
| Periodontal disease | ||
| Pulmonary | Radiation impacting the lungs | Subclinical pulmonary dysfunction |
| Bleomycin | Pulmonary fibrosis | |
| Musculoskeletal | Radiation of musculoskeletal tissues in any patient who is not skeletally mature | Growth impairment |
| Glucocorticosteroids | Bone mineral density deficit (osteoporosis) | |
| Multiple sclerotic bone lesions | ||
| Osteonecrosis [4] | ||
| Immune | Splenectomy | Overwhelming post-splenectomy sepsis |
Source links and citations
Continue within this section
Publication references
Read the original reference and check its publication notices.
Preserved source evidence · Not medical advice