Late effects of therapy for Hodgkin's lymphoma.

Hodgkin's lymphoma exemplifies a malignancy in which the benefits and risks of therapy are strikingly obvious: although 70% to 95% of patients survive (depending on disease stage), the late adverse health effects of therapy compromise quality of life and can be fatal. We review the broad range of these potential effects. Although secondary malignancies and cardiovascular disease are the most life-threatening sequelae, pulmonary, endocrine, and reproductive effects can also substantially compromise quality of life. Specific sequelae are not distributed evenly among survivors but depend on characteristics of the patient and treatment. Recent risk-adapted treatment protocols have eliminated or reduced the use of therapies most associated with adverse effects, such as alkylating agents, anthracyclines, and radiotherapy. Early studies suggest that these strategies reduce the frequency and severity of adverse effects, but additional follow-up of patients is necessary to confirm improved outcomes. Recognition of adverse effects has also led to recommendations for screening.