Adult survivors of Hodgkin lymphoma had nearly twice the mortality of the general United States population, according to a population-based retrospective cohort study of 20,057 long-term survivors.
The analysis examined adults aged 20 years or older who were diagnosed with a first primary Hodgkin lymphoma between 2000 and 2017, received chemotherapy with or without radiotherapy, and survived at least 5 years after diagnosis. Follow-up was available up to December 2023.
The researchers used data from 16 population-based registries within the Surveillance, Epidemiology, and End Results programme to assess excess all-cause mortality among long-term survivors. Mortality was compared with expected deaths in the general United States population, accounting for age, sex, race and ethnicity, and calendar period.
Among the 20,057 survivors, the median age at diagnosis was 36 years. Men accounted for 53.7% of the cohort, while 15.0% were Hispanic, 10.3% were non-Hispanic Black and 69.2% were non-Hispanic White. Nodular sclerosis was reported in 63.4% of patients.
During follow-up, 2,899 deaths were observed compared with 1,480.8 deaths expected in the general population. This corresponded to a standardised mortality ratio of 1.96 (95% confidence interval: 1.89–2.03).
The excess absolute risk was 81.9 additional deaths per 10,000 patient-years (95% confidence interval: 75.8–88.0). Relative mortality risk was higher across all major causes of death, with malignant conditions representing the main contributors to relative mortality.
However, the largest absolute number of excess deaths resulted from other noncancer causes and cardiovascular causes.
The findings highlighted persistent mortality risks among adults who survived Hodgkin lymphoma for at least 5 years. This is particularly relevant as improvements in treatment have contributed to a growing population of long-term survivors.
Previous mortality estimates have often been based on childhood cancer survivors, patients assessed during earlier follow-up, or populations treated before contemporary treatment strategies became widely adopted. The present analysis therefore provided population-based estimates specifically focused on adults diagnosed during a more recent treatment era.
The findings suggested that survivorship care should remain attentive to both cancer-related and noncancer causes of mortality. Although malignant conditions contributed substantially to relative mortality risk, cardiovascular and other noncancer causes accounted for the greatest absolute excess in deaths.
Reference
Valcarcel B et al. Mortality outcomes among long-term hodgkin lymphoma survivors. JAMA Netw Open. 2026;9(8):e2629775.
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