Hodgkin Lymphoma Survivors Face Persistent Excess Mortality Driven by Non-Cancer Causes

The retrospective cohort examined adults diagnosed 2000–2017 with median age 36 at diagnosis. Cancer recurrence accounted for early excess deaths, yet after ten years non-malignant conditions—chiefly cardiovascular disease and second primaries—became the dominant cumulative mortality drivers. Relative risk remained elevated in survivors diagnosed at ages 20–39 and in several racial and ethnic minority groups, while later-era diagnoses showed modestly lower rates consistent with reduced radiotherapy intensity and modern systemic regimens.

SEER data capture broad patterns but lack granular treatment details and comorbidity trajectories, limiting causal inference. Comparable excess mortality patterns appear in other curative-intent lymphoma cohorts followed for decades, suggesting shared late-effect mechanisms rather than HL-specific biology alone. Survivorship guidelines already recommend cardio-oncology screening and secondary-cancer surveillance, yet uptake remains uneven across health systems.

Future studies must link treatment exposures to serial biomarkers and adjudicated cause-of-death data to test whether targeted interventions can narrow the survival gap. Randomized trials embedding risk-adapted follow-up algorithms are the logical next step.