{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:43:39Z","timestamp":1788813819350,"version":"build-2803163510"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T00:00:00Z","timestamp":1608595200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004622","name":"Dutch Cancer Society","doi-asserted-by":"crossref","award":["NKI 2010\u20134720"],"award-info":[{"award-number":["NKI 2010\u20134720"]}],"id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Few studies have examined the impact of treatment-related morbidity on long-term, cause-specific mortality in Hodgkin lymphoma (HL) patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This multicenter cohort included 4919 HL patients, treated before age 51 years between 1965 and 2000, with a median follow-up of 20.2\u2009years. Standardized mortality ratios, absolute excess mortality (AEM) per 10\u2009000 person-years, and cause-specific cumulative mortality by stage and primary treatment, accounting for competing risks, were calculated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>HL patients experienced a 5.1-fold (AEM = 123 excess deaths per 10\u2009000 person-years) higher risk of death due to causes other than HL. This risk remained increased in 40-year survivors (standardized mortality ratio = 5.2, 95% confidence interval [CI] = 4.2 to 6.5, AEM = 619). At age 54\u2009years, HL survivors experienced similar cumulative mortality (20.0%) from causes other than HL to 71-year-old individuals from the general population. Whereas HL mortality statistically significantly decreased over the calendar period (P\u2009&amp;lt;\u2009.001), solid tumor mortality did not change in the most recent treatment era. Patients treated in 1989-2000 had lower 25-year cardiovascular disease mortality than patients treated in 1965-1976 (4.3% vs 5.7%; subdistribution hazard ratio = 0.65, 95% CI = 0.46 to 0.93). Infectious disease mortality was not only increased after splenectomy but also after spleen irradiation (hazard ratio = 2.81, 95% CI = 1.55 to 5.07). For stage I-II, primary treatment with chemotherapy (CT) alone was associated with statistically significantly higher HL mortality (P\u2009&amp;lt;\u2009.001 for CT vs radiotherapy [RT]; P\u2009=\u2009.04 for CT vs RT+CT) but lower 30-year mortality from causes other than HL (15.8%, 95% CI = 9.7% to 23.3%) compared with RT alone (36.9%, 95% CI = 34.0% to 39.8%, P\u2009=\u2009.001) and RT and CT combined (29.8%, 95% CI = 26.8% to 32.9%, P\u2009=\u2009.02).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Compared with the general population, HL survivors have a substantially reduced life expectancy. Optimal selection of patients for primary CT is crucial, weighing risks of HL relapse and long-term toxicity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jnci\/djaa194","type":"journal-article","created":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T20:47:59Z","timestamp":1606942079000},"page":"760-769","source":"Crossref","is-referenced-by-count":99,"title":["Long-Term Cause-Specific Mortality in Hodgkin Lymphoma Patients"],"prefix":"10.1093","volume":"113","author":[{"given":"Simone","family":"de Vries","sequence":"first","affiliation":[{"name":"Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schaapveld","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands"},{"name":"Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the 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Maazen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9e M","family":"Zijlstra","sequence":"additional","affiliation":[{"name":"Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Beijert","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9069-4939","authenticated-orcid":false,"given":"Marten R","family":"Nijziel","sequence":"additional","affiliation":[{"name":"Department of Hematology, Catharina Hospital, Eindhoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karijn M S","family":"Verschueren","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leontien C M","family":"Kremer","sequence":"additional","affiliation":[{"name":"Late Effects Research Group, Princess M\u00e1xima Center for Pediatric Oncology, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M","family":"van Eggermond","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6735-8651","authenticated-orcid":false,"given":"Pieternella J","family":"Lugtenburg","sequence":"additional","affiliation":[{"name":"Department of Hematology, Erasmus MC Cancer 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