The contribution of specific cancer therapies, co-morbid medical conditions, and host factors to mortality risk after pediatric Hodgkin lymphoma (HL) is unclear. We assessed leading morbidities, overall and cause-specific mortality, and mortality risks among 2742 five-year survivors of HL in the Childhood Cancer Survivor Study, a multi-institutional retrospective cohort study of survivors diagnosed from 1970 to 1986. Excess absolute risk (EAR) for leading causes of death, and cumulative incidence and standardized incidence ratios of key medical morbidities were calculated. Cox regression models were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI) of risks for overall and cause-specific mortality. Substantial EAR of mortality per 10,000 person-years was identified: overall 95.5; death due to HL 38.3, second malignant neoplasms (SMN) 23.9, and cardiovascular disease 13.1. Risks for overall mortality included: radiation dose > 30 Gray [supra-diaphragm: HR 3.8; 95%CI 1.1, 12.6; infra+supra-diaphragm: HR 7.8; 95%CI 2.4, 25.1], exposure to anthracycline (HR 2.6; 95%CI 1.6, 4.3) or alkylating agents (HR 1.7; 95%CI 1.2, 2.5), non-breast SMN (HR 2.6; 95%CI 1.4, 5.1), or a serious cardiovascular condition (HR 4.4; 95%CI 2.7, 7.3). Excess mortality from second neoplasms and cardiovascular disease vary by sex, and persist over more than 20 years of follow-up in childhood HL survivors.

  • Submitted April 19, 2010.
  • Accepted October 18, 2010.