Patients with Hodgkin's lymphoma and aggressive non-Hodgkin's lymphoma (NHL) have a relatively high cure rate compared with patients with other hematologic malignancies. Despite these cures, lymphoma survivors continue to have a higher mortality rate than age- and gender-matched peers who have not had the disease. Much of this excess mortality is from second malignancies, which are now recognized as a direct consequence of curative chemotherapy and radiation therapy, and frequently have a poor prognosis. Figure 78.1 shows the cumulative incidence of observed second tumors in a cohort of survivors of Hodgkin's disease and expected tumors in a matched population. Even more than 30 years after diagnosis, patients cured of Hodgkin's lymphoma experience elevated risks of second cancers. In one study, the relative risk of death from second malignancy was 5.1 compared with age-matched controls.1 The recent appreciation of these often-fatal late effects of treatment has focused efforts in both screening and prevention.

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