Late Effects After Treatment of Hodgkin Lymphoma in Childhood and Adolescence

Pediatric Hodgkin lymphoma (HL) has been treated successfully since the late 1970s. In adult patients, high-dose extended field radiation was used for early-stage disease and chemotherapy combinations or combined-modality treatment for advanced disease. In children, chemotherapy was applied across all disease stages, and radiotherapy and field size were reduced. With rising concerns about late effects, number and composition of chemotherapy cycles were adapted to individual risk factors. Radiotherapy was successfully reduced over eight consecutive DAL/GPOH-HD/EuroNet-PHL trials. Therapy was further tailored by using FDG-PET imaging for initial staging and response assessment. Procarbazine was gradually eliminated to reduce the risk of male infertility; etoposide and doxorubicin were substituted to reduce the cumulative alkylating dose. Long-term survivors of pediatric HL are at risk for a wide range of late effects with second malignant neoplasm and cardiovascular diseases as leading causes of death. Other late effects include pulmonary dysfunction, fertility impairment, thyroid dysfunction, fatigue, and local atrophy of muscle and connective tissue. Excess risks remain significantly elevated after decades and are clearly associated with extent of treatment exposures. With adoption of new agents and contemporary treatment techniques, late effect risks need to be further monitored and follow-up recommendations updated.