What noninfectious complications may occur following successful treatment of Hodgkin lymphoma (Hodgkin disease)?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Lhermitte syndrome (an electric-shock sensation that radiates along the back and legs upon flexion of the neck) can occur in approximately 15% of patients after mantle irradiation. Lhermitte syndrome is not associated with the development of radiation myelitis, and it does not require treatment. This syndrome may last for many months, but it will eventually resolve without long-term sequelae.

Elevation of thyroid stimulating hormone (TSH) occurs in one-third of adult patients after neck/mediastinal radiation therapy.

Survivors of Hodgkin lymphoma have an increased incidence of fatigue, psychiatric distress (anxiety, depression), employment problems, family issues, and sexual functioning problems, as compared to individuals without this disease or relative to survivors of acute leukemia. [108, 109]

Peripheral neuropathy occurred in 29% of patients receiving brentuximab vedotin as part of the A+AVD regimen as opposed to 17% of those who received ABVD. [54] The neuropathy resolved in 43%of the patients and improved in another 23%.

Nivolumab and pembrolizumab are used as salvage therapy in Hodgkin lymphoma and can have numerous autoimmune side effects as a result of immune checkpoint inhibition. This can include pneumonitis, colitis, nephritis, hypothyroidism, hypopituitarism, and adrenalitis. High-dose corticosteroids may be required to treat these side effects. Hypothyroidism requires thyroid hormone replacement and adrenal insuffiency requires physiologic replacement of corticosteroids and mineralocorticoids.

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