{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T09:07:20Z","timestamp":1788599240409,"version":"build-2803163510"},"reference-count":47,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"13","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Balancing disease control and toxicity from chemotherapy and radiotherapy (RT) when treating early-stage classical Hodgkin lymphoma (cHL) is important. Available data on long-term toxicity after RT for cHL mostly refer to RT techniques no longer in use. We aimed to describe long-term toxicity from modern limited-field (LF)-RT after two or four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). <\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS AND METHODS<\/jats:title><jats:p> This study included all patients with cHL treated with two or four cycles of ABVD and 30 Gy LF-RT during 1999-2005 in Sweden. Patients (n = 215) and comparators (n = 860), matched for age, gender, and region of residence, were cross-checked against national health registries for malignancies, diseases of the circulatory system (DCS), and diseases of the respiratory system (DRS) from the day of diagnosis of cHL. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> The risk of a malignancy was higher for patients than comparators, hazard ratio (HR) 1.5 (95% CI, 1.0 to 2.4), as was the risk for DCS 1.5 (95% CI, 1.1 to 2.0) and for DRS 2.6 (95% CI, 1.6 to 4.3). The median follow-up was 16 years (range, 12-19 years). Of individual diagnoses in DCS, only venous thromboembolism was statistically significantly elevated. If the first 6 months (ie, time of active treatment for cHL) were excluded and censoring at relapse of cHL or diagnosis of any malignancy, the increased HR for venous thromboembolism diminished. Most of the excess risk for DRS consisted of asthma, HR 3.5 (95% CI, 1.8 to 6.8). Patients diagnosed with DRS were significantly younger than comparators. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Compared with toxicity from earlier RT techniques, excess morbidity was not eliminated, but lower than previously reported. The elevated risk of DRS was driven by diagnosis of asthma, which could in part be explained by misdiagnosis of persisting pulmonary toxicity. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.21.02407","type":"journal-article","created":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T20:59:30Z","timestamp":1643144370000},"page":"1487-1496","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":16,"title":["Limited, But Not Eliminated, Excess Long-Term Morbidity in Stage I-IIA Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine and Limited-Field Radiotherapy"],"prefix":"10.1200","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3871-014X","authenticated-orcid":false,"given":"Ingemar","family":"Lagerl\u00f6f","sequence":"first","affiliation":[{"name":"Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology; Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4336-0949","authenticated-orcid":false,"given":"Helena","family":"Fohlin","sequence":"additional","affiliation":[{"name":"Regional Cancer Center of Southeast Sweden and Department of Biomedical and Clinical Sciences, Medical Faculty, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0594-724X","authenticated-orcid":false,"given":"Gunilla","family":"Enblad","sequence":"additional","affiliation":[{"name":"Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology; Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bengt","family":"Glimelius","sequence":"additional","affiliation":[{"name":"Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology; Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1263-7538","authenticated-orcid":false,"given":"Christina","family":"Goldkuhl","sequence":"additional","affiliation":[{"name":"Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4287-3179","authenticated-orcid":false,"given":"Marzia","family":"Palma","sequence":"additional","affiliation":[{"name":"Department of Haematology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"\u00c5kesson","sequence":"additional","affiliation":[{"name":"Regional Cancer Center of Southeast Sweden and Department of Biomedical and Clinical Sciences, Medical Faculty, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6158-3041","authenticated-orcid":false,"given":"Ingrid","family":"Glimelius","sequence":"additional","affiliation":[{"name":"Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology; Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Molin","sequence":"additional","affiliation":[{"name":"Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology; Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000067"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1016\/0167-8140(90)90138-M"},{"key":"b3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408648"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.68.6394"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.00964"},{"key":"b6","first-page":"1268","volume":"26","author":"Kaplan HS","year":"1966","journal-title":"Cancer Res"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V59.3.455.455"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1985.3.2.207"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-07-034405"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.1080\/10428190802140873"},{"key":"b11","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.1180"},{"key":"b12","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.49.3205"},{"key":"b13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.0936"},{"key":"b14","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6604244"},{"key":"b15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1505949"},{"key":"b16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.21.1920"},{"key":"b17","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-78-4-618_1"},{"key":"b18","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1994.12.2.297"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.4.1297"},{"key":"b20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.08.041"},{"key":"b21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.05.005"},{"key":"b22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.12.039"},{"key":"b23","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djv018"},{"key":"b24","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30601-X"},{"key":"b25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.00108"},{"key":"b26","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16232"},{"key":"b27","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.06.046"},{"key":"b28","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2020.1768385"},{"key":"b29","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24623"},{"key":"b30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.04.093"},{"key":"b31","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2015.03.005"},{"key":"b32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.01.053"},{"key":"b33","unstructured":"Marubini E, Valsecchi MG: Statistics in Practice: Analysing Survival Data from Clinical Trials and Observational Studies. Chichester, United Kingdom, John Wiley and Sons, 1995, pp 331-363"},{"key":"b34","volume-title":"Stata Statistical Software","year":"2013","edition":"13"},{"key":"b35","volume-title":"A Language and Environment for Statistical Computing","author":"R Core Team","year":"2020"},{"key":"b36","volume-title":"Area-Proportional Euler and Venn Diagrams With Ellipses","author":"Larsson J","year":"2020"},{"key":"b37","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.34.8268"},{"key":"b38","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djk029"},{"key":"b39","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz168"},{"key":"b40","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2014.946901"},{"key":"b41","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157651"},{"key":"b42","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1510093"},{"key":"b43","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdn284"},{"key":"b44","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-10-94"},{"key":"b45","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.02.7243"},{"key":"b46","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30784-8"},{"key":"b47","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30696-4"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.21.02407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T10:52:36Z","timestamp":1653821556000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.21.02407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,1]]},"references-count":47,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2022,5,1]]}},"alternative-id":["10.1200\/JCO.21.02407"],"URL":"https:\/\/doi.org\/10.1200\/jco.21.02407","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,1]]},"assertion":[{"value":"2021-10-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-11","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}