title: Risk of premature menopause after treatment for Hodgkin's lymphoma.
abstract: BACKGROUND
  Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited.
  
  
  METHODS
  Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided.
  
  
  RESULTS
  During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided.
  
  
  CONCLUSIONS
  Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Swerdlow
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Rosie
authors.initials: R
authors.lastname: Cooke
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Andrew
authors.initials: A
authors.lastname: Bates
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Falk
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Dianne
authors.initials: D
authors.lastname: Gilson
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Barry W
authors.initials: BW
authors.lastname: Hancock
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Harris
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Alan
authors.initials: A
authors.lastname: Horwich
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hoskin
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: David C
authors.initials: DC
authors.lastname: Linch
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Andrew
authors.initials: A
authors.lastname: Lister
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Helen H
authors.initials: HH
authors.lastname: Lucraft
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: John
authors.initials: J
authors.lastname: Radford
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Stevens
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Isabel
authors.initials: I
authors.lastname: Syndikus
authors.affiliation: Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
authors.forename: Michael V
authors.initials: MV
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004739:England / Q000453:epidemiology; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008594:Menopause, Premature; D010053:Ovary / Q000528:radiation effects*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003561:Cytarabine; D001761:Bleomycin; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D004317:Doxorubicin; D008558:Melphalan; D002330:Carmustine