Predictors of Secondary Lung Cancer Among Hodgkin Lymphoma Survivors: A Nationwide Analysis

  • Yanal Alnimer
    Address for correspondence: Yanal Alnimer, Hospital Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA.
    Hospital Medicine, Virginia Commonwealth University, Richmond, VA

    Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Search for articles by this author
  • Moaath K. Mustafa Ali
    University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD

    Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
    Search for articles by this author
Published:August 06, 2022DOI:



      There is insufficient data regarding the incidence rate of secondary lung cancer among Hodgkin lymphoma (HL) survivors and the predisposing factors.


      We analyzed the data from the cohort of patients who had HL between 1973 and 2015 using the Surveillance Epidemiology and End Results database (SEER). Data on patient's age, gender, year of diagnosis with HL, Ann-Arbor stage, Histology, racial groups, date of last follow-up, date of death, and treatment modalities were collected.


      We identified a total of 56,856 patients with HL; of those, 862 had secondary lung cancer, with an incidence rate of 157 (95%CI: 147-168) per 100,000 person-years. The median overall survival from time of HL diagnosis for those with secondary lung cancer was 12.1 years (95% CI: 10.7-13) compared to 27.1 years (95% CI: 26.5-27.6) for those who did not develop lung cancer (log-rank P-value of <.01). After propensity score weighting, radiation therapy was associated with a higher risk of secondary lung cancer (hazard ratio (HR): 1.23, 95% CI: 1.002-1.55) with a P-value of 0.048. Older age at the time of HL diagnosis and male gender were associated with higher risk, with an HR of 1.07 (95% CI 1.062-1.073) and an HR of 1.602 (95% CI 1.33-1.94), respectively. Furthermore, chemotherapy increased the risk only among older age groups.


      Older age at the time of HL diagnosis, male gender, radiation therapy, and chemotherapy only among older age groups were associated with higher risk for secondary lung cancer, with 50% of the cases occurring within 9.1 years following HL diagnosis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Lung Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Torre LA
        • Siegel RL
        • Jemal A.
        Lung cancer statistics.
        Adv Exp Med Biol. 2016; 893: 1-19
        • Aberle DR
        • Adams AM
        • Berg CD
        • et al.
        Reduced lung-cancer mortality with low-dose computed tomographic screening.
        N Engl J Med. 2011; 365: 395-409
        • Ibrahim EM
        • Kazkaz GA
        • Abouelkhair KM
        • et al.
        Increased risk of second lung cancer in Hodgkin’s lymphoma survivors: a meta-analysis.
        Lung. 2013; 191: 117-134
        • Tindle HA
        • Duncan MS
        • Greevy RA
        • et al.
        Lifetime Smoking History and Risk of Lung Cancer: Results From the Framingham Heart Study.
        J Natl Cancer Inst. 2018; 110: 1201-1207
        • Bain C
        • Feskanich D
        • Speizer FE
        • et al.
        Lung cancer rates in men and women with comparable histories of smoking.
        J Natl Cancer Inst. 2004; 96: 826-834
        • Swerdlow AJ
        • Schoemaker MJ
        • Allerton R
        • et al.
        Lung cancer after Hodgkin’s disease: a nested case-control study of the relation to treatment.
        J Clin Oncol. 2001; 19: 1610-1618
        • Travis LB
        • Curtis RE
        • Bennett WP
        • Hankey BF
        • Travis WD
        • Boice JD.
        Lung cancer after Hodgkin's disease.
        J Natl Cancer Inst. 1995; 87: 1324-1327
        • Toh C-K
        • Wan-Teck Lim FG
        • Leong SS
        • et al.
        Never-smokers with lung cancer: epidemiologic evidence of a distinct disease entity.
        J Clin Oncol. 2006; 24: 2245-2251
        • Wattson DA
        • Hunink MG
        • DiPiro PJ
        • et al.
        Low-dose chest computed tomography for lung cancer screening among Hodgkin lymphoma survivors: a cost-effectiveness analysis.
        Int J Radiat Oncol Biol Phys. 2014; 90: 344-353
        • Schoenfeld JD
        • Mauch PM
        • Das P
        • et al.
        Lung malignancies after Hodgkin lymphoma: disease characteristics, detection methods and clinical outcome.
        Ann Oncol. 2012; 23: 1813-1818
        • Tammemägi MC
        • Haaf KT
        • Toumazis I
        • et al.
        Development and validation of a multivariable lung cancer risk prediction model that includes low-dose computed tomography screening results: a secondary analysis of data from the National Lung Screening Trial.
        JAMA Netw open. 2019; 2e190204
        • Laurie SA
        • Kris MG
        • Portlock CS
        • et al.
        The clinical course of nonsmall cell lung carcinoma in survivors of Hodgkin disease.
        Cancer. 2002; 95: 119-126
        • Lightwood J
        • Glantz SA.
        Smoking behavior and healthcare expenditure in the United States, 1992-2009: panel data estimates.
        PLoS Med. 2016; 13e1002020
        • Harder VS
        • Stuart EA
        • Anthony JC.
        Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research.
        Psycholl methods. 2010; 15: 234-249
        • Kahn JM
        • Keegan THM
        • Tao L
        • Abrahão R
        • Bleyer A
        • Viny AD.
        Racial disparities in the survival of American children, adolescents, and young adults with acute lymphoblastic leukemia, acute myelogenous leukemia, and Hodgkin lymphoma.
        Cancer. 2016; 122: 2723-2730
        • Coughlin SS
        • Matthews-Juarez P
        • Juarez PD
        • Melton CE
        • King M.
        Opportunities to address lung cancer disparities among African Americans.
        Cancer Med. 2014; 3: 1467-1476