UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Overview of the approach to the adult survivor of classical Hodgkin lymphoma

Authors
Andrea K Ng, MD, MPH
Ann S LaCasce, MD
Section Editor
Larissa Nekhlyudov, MD, MPH
Deputy Editor
Alan G Rosmarin, MD

INTRODUCTION

Hodgkin lymphoma (HL), formerly called Hodgkin's disease, accounts for approximately 10 percent of all lymphomas diagnosed in the developed world annually [1]. This amounts to approximately 8830 new cases of HL in the United States annually [2]. Over the past century, HL has been converted from a uniformly fatal disease to one that is curable in greater than 75 percent of patients worldwide. As a result, there are more than 30,000 long-term survivors of HL in the United States alone [3], and many more throughout the world, a substantial percentage of whom will have the majority of their care delivered by primary care providers. (See "Overview of the treatment of classical Hodgkin lymphoma in adults".)

HL is separated from the other lymphomas based on its unique clinical and pathologic features and can be divided into two major types:

Classical HL – Subtypes include nodular sclerosis HL, mixed cellularity HL, lymphocyte rich HL, and lymphocyte depleted HL. These constitute the vast majority of HL and will be discussed here.

Nodular lymphocyte-predominant HL – This is a less common and more indolent disease than classical HL and is therefore managed uniquely. (See "Clinical manifestations, pathologic features, and diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma".)

HL survivors are at risk of developing therapy-related complications that may present years after treatment (eg, second malignancies, cardiac disease, radiation-induced hypothyroidism). These complications have surfaced as significant causes of increased mortality among HL survivors. Screening for some of these entities is advised in the hope that early detection may lead to better management.

                              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Oct 05 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin 2009; 59:225.
  2. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212.
  3. Mariotto AB, Rowland JH, Yabroff KR, et al. Long-term survivors of childhood cancers in the United States. Cancer Epidemiol Biomarkers Prev 2009; 18:1033.
  4. Yahalom J, Mauch P. The involved field is back: issues in delineating the radiation field in Hodgkin's disease. Ann Oncol 2002; 13 Suppl 1:79.
  5. Specht L, Yahalom J, Illidge T, et al. Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phys 2014; 89:854.
  6. Kaplan HS, Rosenberg SA. The treatment of Hodgkin's disease. Med Clin North Am 1966; 50:1591.
  7. DeVita VT Jr, Simon RM, Hubbard SM, et al. Curability of advanced Hodgkin's disease with chemotherapy. Long-term follow-up of MOPP-treated patients at the National Cancer Institute. Ann Intern Med 1980; 92:587.
  8. Devita VT Jr, Serpick AA, Carbone PP. Combination chemotherapy in the treatment of advanced Hodgkin's disease. Ann Intern Med 1970; 73:881.
  9. Bonadonna G, Zucali R, Monfardini S, et al. Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer 1975; 36:252.
  10. Santoro A, Bonadonna G, Valagussa P, et al. Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol 1987; 5:27.
  11. Canellos GP, Anderson JR, Propert KJ, et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992; 327:1478.
  12. National Comprehensive Cancer Network (NCCN) guidelines available online at www.nccn.org.
  13. Brenner H, Gondos A, Pulte D. Survival expectations of patients diagnosed with Hodgkin's lymphoma in 2006-2010. Oncologist 2009; 14:806.
  14. Storm HH, Klint A, Tryggvadóttir L, et al. Trends in the survival of patients diagnosed with malignant neoplasms of lymphoid, haematopoietic, and related tissue in the Nordic countries 1964-2003 followed up to the end of 2006. Acta Oncol 2010; 49:694.
  15. Bessell EM, Bouliotis G, Armstrong S, et al. Long-term survival after treatment for Hodgkin's disease (1973-2002): improved survival with successive 10-year cohorts. Br J Cancer 2012; 107:531.
  16. Engert A, Plütschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med 2010; 363:640.
  17. Fermé C, Eghbali H, Meerwaldt JH, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med 2007; 357:1916.
  18. Sjöberg J, Halthur C, Kristinsson SY, et al. Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009. Blood 2012; 119:990.
  19. Eich HT, Diehl V, Görgen H, et al. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol 2010; 28:4199.
  20. Aleman BM, Raemaekers JM, Tirelli U, et al. Involved-field radiotherapy for advanced Hodgkin's lymphoma. N Engl J Med 2003; 348:2396.
  21. Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med 2003; 348:2386.
  22. Federico M, Luminari S, Iannitto E, et al. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin's lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. J Clin Oncol 2009; 27:805.
  23. Diehl V, Haverkamp H, Mueller R, et al. Eight cycles of BEACOPP escalated compared with 4 cycles of BEACOPP escalated followed by 4 cycles of BEACOPP baseline with or without radiotherapy in patients in advanced stage Hodgkin lymphoma (HL): Final analysis of the HD12 trial of the German Hodgkin Study Group (GHSG). J Clin Oncol 2009; 27:15s.
  24. Viviani S, Santoro A, Ragni G, et al. Gonadal toxicity after combination chemotherapy for Hodgkin's disease. Comparative results of MOPP vs ABVD. Eur J Cancer Clin Oncol 1985; 21:601.
  25. Kaldor JM, Day NE, Clarke EA, et al. Leukemia following Hodgkin's disease. N Engl J Med 1990; 322:7.
  26. Kaldor JM, Day NE, Bell J, et al. Lung cancer following Hodgkin's disease: a case-control study. Int J Cancer 1992; 52:677.
  27. Swerdlow AJ, Schoemaker MJ, Allerton R, et al. Lung cancer after Hodgkin's disease: a nested case-control study of the relation to treatment. J Clin Oncol 2001; 19:1610.
  28. Travis LB, Gospodarowicz M, Curtis RE, et al. Lung cancer following chemotherapy and radiotherapy for Hodgkin's disease. J Natl Cancer Inst 2002; 94:182.
  29. van den Belt-Dusebout AW, Aleman BM, Besseling G, et al. Roles of radiation dose and chemotherapy in the etiology of stomach cancer as a second malignancy. Int J Radiat Oncol Biol Phys 2009; 75:1420.
  30. Valagussa P, Santoro A, Fossati-Bellani F, et al. Second acute leukemia and other malignancies following treatment for Hodgkin's disease. J Clin Oncol 1986; 4:830.
  31. van Leeuwen FE, Chorus AM, van den Belt-Dusebout AW, et al. Leukemia risk following Hodgkin's disease: relation to cumulative dose of alkylating agents, treatment with teniposide combinations, number of episodes of chemotherapy, and bone marrow damage. J Clin Oncol 1994; 12:1063.
  32. Cil T, Altintas A, Tamam Y, et al. Low dose vincristine-induced severe polyneuropathy in a Hodgkin lymphoma patient: a case report (vincristine-induced severe polyneuropathy). J Pediatr Hematol Oncol 2009; 31:787.
  33. Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001; 120:617.
  34. Martin WG, Ristow KM, Habermann TM, et al. Bleomycin pulmonary toxicity has a negative impact on the outcome of patients with Hodgkin's lymphoma. J Clin Oncol 2005; 23:7614.
  35. Hirsch A, Vander Els N, Straus DJ, et al. Effect of ABVD chemotherapy with and without mantle or mediastinal irradiation on pulmonary function and symptoms in early-stage Hodgkin's disease. J Clin Oncol 1996; 14:1297.
  36. Swerdlow AJ, Higgins CD, Smith P, et al. Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 2007; 99:206.
  37. Avilés A, Neri N, Nambo JM, et al. Late cardiac toxicity secondary to treatment in Hodgkin's disease. A study comparing doxorubicin, epirubicin and mitoxantrone in combined therapy. Leuk Lymphoma 2005; 46:1023.
  38. Myrehaug S, Pintilie M, Tsang R, et al. Cardiac morbidity following modern treatment for Hodgkin lymphoma: supra-additive cardiotoxicity of doxorubicin and radiation therapy. Leuk Lymphoma 2008; 49:1486.
  39. Ng AK, Bernardo MP, Weller E, et al. Long-term survival and competing causes of death in patients with early-stage Hodgkin's disease treated at age 50 or younger. J Clin Oncol 2002; 20:2101.
  40. Aleman BM, van den Belt-Dusebout AW, Klokman WJ, et al. Long-term cause-specific mortality of patients treated for Hodgkin's disease. J Clin Oncol 2003; 21:3431.
  41. Dores GM, Metayer C, Curtis RE, et al. Second malignant neoplasms among long-term survivors of Hodgkin's disease: a population-based evaluation over 25 years. J Clin Oncol 2002; 20:3484.
  42. Ng AK, Bernardo MV, Weller E, et al. Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. Blood 2002; 100:1989.
  43. Hodgson DC, Gilbert ES, Dores GM, et al. Long-term solid cancer risk among 5-year survivors of Hodgkin's lymphoma. J Clin Oncol 2007; 25:1489.
  44. Weber DC, Johanson S, Peguret N, et al. Predicted risk of radiation-induced cancers after involved field and involved node radiotherapy with or without intensity modulation for early-stage hodgkin lymphoma in female patients. Int J Radiat Oncol Biol Phys 2011; 81:490.
  45. Maraldo MV, Brodin NP, Vogelius IR, et al. Risk of developing cardiovascular disease after involved node radiotherapy versus mantle field for Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 2012; 83:1232.
  46. Ng AK. Review of the cardiac long-term effects of therapy for Hodgkin lymphoma. Br J Haematol 2011; 154:23.
  47. Bhakta N, Liu Q, Yeo F, et al. Cumulative burden of cardiovascular morbidity in paediatric, adolescent, and young adult survivors of Hodgkin's lymphoma: an analysis from the St Jude Lifetime Cohort Study. Lancet Oncol 2016; 17:1325.
  48. Aleman BM, van den Belt-Dusebout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood 2007; 109:1878.
  49. Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. JAMA 2003; 290:2831.
  50. Myrehaug S, Pintilie M, Yun L, et al. A population-based study of cardiac morbidity among Hodgkin lymphoma patients with preexisting heart disease. Blood 2010; 116:2237.
  51. Galper SL, Yu JB, Mauch PM, et al. Clinically significant cardiac disease in patients with Hodgkin lymphoma treated with mediastinal irradiation. Blood 2011; 117:412.
  52. Küpeli S, Hazirolan T, Varan A, et al. Evaluation of coronary artery disease by computed tomography angiography in patients treated for childhood Hodgkin's lymphoma. J Clin Oncol 2010; 28:1025.
  53. van Nimwegen FA, Schaapveld M, Janus CP, et al. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med 2015; 175:1007.
  54. Heidenreich PA, Hancock SL, Lee BK, et al. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 2003; 42:743.
  55. Bowers DC, McNeil DE, Liu Y, et al. Stroke as a late treatment effect of Hodgkin's Disease: a report from the Childhood Cancer Survivor Study. J Clin Oncol 2005; 23:6508.
  56. De Bruin ML, Dorresteijn LD, van't Veer MB, et al. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma. J Natl Cancer Inst 2009; 101:928.
  57. Abratt RP, Morgan GW, Silvestri G, Willcox P. Pulmonary complications of radiation therapy. Clin Chest Med 2004; 25:167.
  58. Gustavsson A, Eskilsson J, Landberg T, et al. Long-term effects on pulmonary function of mantle radiotherapy in patients with Hodgkin's disease. Ann Oncol 1992; 3:455.
  59. Lund MB, Kongerud J, Nome O, et al. Lung function impairment in long-term survivors of Hodgkin's disease. Ann Oncol 1995; 6:495.
  60. Ng AK, Abramson JS, Digumarthy SR, et al. Case records of the Massachusetts General Hospital. Case 24-2010. A 56-year-old woman with a history of Hodgkin's lymphoma and sudden onset of dyspnea and shock. N Engl J Med 2010; 363:664.
  61. Knobel H, Håvard Loge J, Lund MB, et al. Late medical complications and fatigue in Hodgkin's disease survivors. J Clin Oncol 2001; 19:3226.
  62. Ng AK, Li S, Neuberg D, et al. A prospective study of pulmonary function in Hodgkin's lymphoma patients. Ann Oncol 2008; 19:1754.
  63. Longo DL, Young RC, Wesley M, et al. Twenty years of MOPP therapy for Hodgkin's disease. J Clin Oncol 1986; 4:1295.
  64. Chapman RM, Sutcliffe SB, Rees LH, et al. Cyclical combination chemotherapy and gonadal function. Retrospective study in males. Lancet 1979; 1:285.
  65. Viviani S, Ragni G, Santoro A, et al. Testicular dysfunction in Hodgkin's disease before and after treatment. Eur J Cancer 1991; 27:1389.
  66. De Bruin ML, Huisbrink J, Hauptmann M, et al. Treatment-related risk factors for premature menopause following Hodgkin lymphoma. Blood 2008; 111:101.
  67. Brämswig JH, Riepenhausen M, Schellong G. Parenthood in adult female survivors treated for Hodgkin's lymphoma during childhood and adolescence: a prospective, longitudinal study. Lancet Oncol 2015; 16:667.
  68. Anselmo AP, Cartoni C, Bellantuono P, et al. Risk of infertility in patients with Hodgkin's disease treated with ABVD vs MOPP vs ABVD/MOPP. Haematologica 1990; 75:155.
  69. Hodgson DC, Pintilie M, Gitterman L, et al. Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol 2007; 25:11.
  70. Behringer K, Breuer K, Reineke T, et al. Secondary amenorrhea after Hodgkin's lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin's Lymphoma Study Group. J Clin Oncol 2005; 23:7555.
  71. Sieniawski M, Reineke T, Nogova L, et al. Fertility in male patients with advanced Hodgkin lymphoma treated with BEACOPP: a report of the German Hodgkin Study Group (GHSG). Blood 2008; 111:71.
  72. Ortin TT, Shostak CA, Donaldson SS. Gonadal status and reproductive function following treatment for Hodgkin's disease in childhood: the Stanford experience. Int J Radiat Oncol Biol Phys 1990; 19:873.
  73. van der Kaaij MA, Heutte N, Meijnders P, et al. Premature ovarian failure and fertility in long-term survivors of Hodgkin's lymphoma: a European Organisation for Research and Treatment of Cancer Lymphoma Group and Groupe d'Etude des Lymphomes de l'Adulte Cohort Study. J Clin Oncol 2012; 30:291.
  74. Kiserud CE, Fosså A, Holte H, Fosså SD. Post-treatment parenthood in Hodgkin's lymphoma survivors. Br J Cancer 2007; 96:1442.
  75. Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin's disease. N Engl J Med 1991; 325:599.
  76. Sklar C, Whitton J, Mertens A, et al. Abnormalities of the thyroid in survivors of Hodgkin's disease: data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab 2000; 85:3227.
  77. Constine LS, Donaldson SS, McDougall IR, et al. Thyroid dysfunction after radiotherapy in children with Hodgkin's disease. Cancer 1984; 53:878.
  78. van Nimwegen FA, Schaapveld M, Janus CP, et al. Risk of diabetes mellitus in long-term survivors of Hodgkin lymphoma. J Clin Oncol 2014; 32:3257.
  79. Pace A, Bove L, Nisticò C, et al. Vinorelbine neurotoxicity: clinical and neurophysiological findings in 23 patients. J Neurol Neurosurg Psychiatry 1996; 61:409.
  80. Malow BA, Dawson DM. Neuralgic amyotrophy in association with radiation therapy for Hodgkin's disease. Neurology 1991; 41:440.
  81. Furby A, Béhin A, Lefaucheur JP, et al. Late-onset cervicoscapular muscle atrophy and weakness after radiotherapy for Hodgkin disease: a case series. J Neurol Neurosurg Psychiatry 2010; 81:101.
  82. Rowin J, Cheng G, Lewis SL, Meriggioli MN. Late appearance of dropped head syndrome after radiotherapy for Hodgkin's disease. Muscle Nerve 2006; 34:666.
  83. van Leeuwen-Segarceanu EM, Dorresteijn LD, Pillen S, et al. Progressive muscle atrophy and weakness after treatment by mantle field radiotherapy in Hodgkin lymphoma survivors. Int J Radiat Oncol Biol Phys 2012; 82:612.
  84. Loge JH, Abrahamsen AF, Ekeberg O, Kaasa S. Hodgkin's disease survivors more fatigued than the general population. J Clin Oncol 1999; 17:253.
  85. Arden-Close E, Pacey A, Eiser C. Health-related quality of life in survivors of lymphoma: a systematic review and methodological critique. Leuk Lymphoma 2010; 51:628.
  86. Heutte N, Flechtner HH, Mounier N, et al. Quality of life after successful treatment of early-stage Hodgkin's lymphoma: 10-year follow-up of the EORTC-GELA H8 randomised controlled trial. Lancet Oncol 2009; 10:1160.
  87. Hjermstad MJ, Oldervoll L, Fosså SD, et al. Quality of life in long-term Hodgkin's disease survivors with chronic fatigue. Eur J Cancer 2006; 42:327.
  88. Ng AK, Li S, Recklitis C, et al. A comparison between long-term survivors of Hodgkin's disease and their siblings on fatigue level and factors predicting for increased fatigue. Ann Oncol 2005; 16:1949.
  89. Rüffer JU, Flechtner H, Tralls P, et al. Fatigue in long-term survivors of Hodgkin's lymphoma; a report from the German Hodgkin Lymphoma Study Group (GHSG). Eur J Cancer 2003; 39:2179.
  90. Loge JH, Abrahamsen AF, Kaasa S. Fatigue and psychiatric morbidity among Hodgkin's disease survivors. J Pain Symptom Manage 2000; 19:91.
  91. Miltényi Z, Magyari F, Simon Z, Illés A. Quality of life and fatigue in Hodgkin's lymphoma patients. Tumori 2010; 96:594.
  92. Daniëls LA, Oerlemans S, Krol AD, et al. Chronic fatigue in Hodgkin lymphoma survivors and associations with anxiety, depression and comorbidity. Br J Cancer 2014; 110:868.
  93. Adams MJ, Lipsitz SR, Colan SD, et al. Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. J Clin Oncol 2004; 22:3139.
  94. Krull KR, Sabin ND, Reddick WE, et al. Neurocognitive function and CNS integrity in adult survivors of childhood hodgkin lymphoma. J Clin Oncol 2012; 30:3618.
  95. Hannah M, Gritz E, Wellisch D, et al. Changes in marital and sexual functioning in long-term survivors and their spouses: Testicular cancer versus hodgkin's disease. Psychooncology 1992; 1:89.
  96. Chen A, Feng Y, Neuberg D, et al. Employment and insurance status in Hodgkin lymphoma survivors. Int J Radiat Oncol Biol Phys 2008; 72:S138.
  97. Recklitis CJ, Sanchez Varela V, Ng A, et al. Sexual functioning in long-term survivors of Hodgkin's lymphoma. Psychooncology 2010; 19:1229.
  98. Behringer K, Müller H, Görgen H, et al. Sexual quality of life in Hodgkin Lymphoma: a longitudinal analysis by the German Hodgkin Study Group. Br J Cancer 2013; 108:49.
  99. Dryver ET, Jernström H, Tompkins K, et al. Follow-up of patients with Hodgkin's disease following curative treatment: the routine CT scan is of little value. Br J Cancer 2003; 89:482.
  100. Jerusalem G, Beguin Y, Fassotte MF, et al. Early detection of relapse by whole-body positron emission tomography in the follow-up of patients with Hodgkin's disease. Ann Oncol 2003; 14:123.
  101. Torrey MJ, Poen JC, Hoppe RT. Detection of relapse in early-stage Hodgkin's disease: role of routine follow-up studies. J Clin Oncol 1997; 15:1123.
  102. Zinzani PL, Stefoni V, Tani M, et al. Role of [18F]fluorodeoxyglucose positron emission tomography scan in the follow-up of lymphoma. J Clin Oncol 2009; 27:1781.
  103. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004; 351:427.
  104. Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007; 57:75.
  105. Long-term follow-up guidelines for survivors of childhood, adolescent and young adult cancers. www.survivorshipguidelines.org.
  106. Friedman DL, Whitton J, Leisenring W, et al. Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst 2010; 102:1083.
  107. Heidenreich PA, Hancock SL, Vagelos RH, et al. Diastolic dysfunction after mediastinal irradiation. Am Heart J 2005; 150:977.
  108. Heidenreich PA, Schnittger I, Strauss HW, et al. Screening for coronary artery disease after mediastinal irradiation for Hodgkin's disease. J Clin Oncol 2007; 25:43.
  109. Ng AK, Li S, Recklitis C, et al. Health practice in long-term survivors of Hodgkin's lymphoma. Int J Radiat Oncol Biol Phys 2008; 71:468.
  110. Jones LW, Liu Q, Armstrong GT, et al. Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study. J Clin Oncol 2014; 32:3643.
  111. Oldervoll LM, Kaasa S, Knobel H, Loge JH. Exercise reduces fatigue in chronic fatigued Hodgkins disease survivors--results from a pilot study. Eur J Cancer 2003; 39:57.
  112. Horning SJ, Hoppe RT, Kaplan HS, Rosenberg SA. Female reproductive potential after treatment for Hodgkin's disease. N Engl J Med 1981; 304:1377.
  113. Langagergaard V, Horvath-Puho E, Nørgaard M, et al. Hodgkin's disease and birth outcome: a Danish nationwide cohort study. Br J Cancer 2008; 98:183.
  114. Holmes GE, Holmes FF. Pregnancy outcome of patients treated for Hodgkin's disease: a controlled study. Cancer 1978; 41:1317.
  115. Green DM, Hall B. Pregnancy outcome following treatment during childhood or adolescence for Hodgkin's disease. Pediatr Hematol Oncol 1988; 5:269.
  116. De Sanctis V, Filippone FR, Alfò M, et al. Impact of different treatment approaches on pregnancy outcomes in 99 women treated for Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 2012; 84:755.
  117. van der Kaaij MA, Heutte N, Meijnders P, et al. Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study. J Clin Oncol 2012; 30:3854.
  118. Byrne J, Rasmussen SA, Steinhorn SC, et al. Genetic disease in offspring of long-term survivors of childhood and adolescent cancer. Am J Hum Genet 1998; 62:45.
  119. Sankila R, Olsen JH, Anderson H, et al. Risk of cancer among offspring of childhood-cancer survivors. Association of the Nordic Cancer Registries and the Nordic Society of Paediatric Haematology and Oncology. N Engl J Med 1998; 338:1339.
  120. Bodis S, Henry-Amar M, Bosq J, et al. Late relapse in early-stage Hodgkin's disease patients enrolled on European Organization for Research and Treatment of Cancer protocols. J Clin Oncol 1993; 11:225.
  121. Garcia-Carbonero R, Paz-Ares L, Arcediano A, et al. Favorable prognosis after late relapse of Hodgkin's disease. Cancer 1998; 83:560.
  122. Weibull CE, Eloranta S, Smedby KE, et al. Pregnancy and the Risk of Relapse in Patients Diagnosed With Hodgkin Lymphoma. J Clin Oncol 2016; 34:337.
  123. Mandel SJ, Larsen PR, Seely EW, Brent GA. Increased need for thyroxine during pregnancy in women with primary hypothyroidism. N Engl J Med 1990; 323:91.
  124. Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr 2010; 2010:25.
  125. Nathan PC, Greenberg ML, Ness KK, et al. Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 2008; 26:4401.