title: Pregnancy and the Risk of Relapse in Patients Diagnosed With Hodgkin Lymphoma.
abstract: OBJECTIVE
  Many patients and clinicians are worried that pregnancy after the diagnosis of Hodgkin lymphoma (HL) may increase the risk of relapse despite a lack of empirical evidence to support such concerns. We investigated if an association exists between pregnancy and relapse in women with a diagnosis of HL.
  
  
  METHODS
  Using Swedish healthcare registers combined with medical records, we included 449 women who received a diagnosis of HL between 1992 and 2009 and who were age 18 to 40 years at diagnosis. Follow-up started 6 months after diagnosis, when the patients' condition was assumed to be in remission. Pregnancy-associated relapse was defined as a relapse during pregnancy or within 5 years after delivery. Hazard ratios (HRs) with 95% CIs were estimated by using the Cox proportional hazards model.
  
  
  RESULTS
  Among the 449 women, 144 (32%) became pregnant during follow-up. Overall, 47 relapses were recorded, of which one was a pregnancy-associated relapse. The adjusted HR for the comparison of the pregnancy-associated relapse rate to the non-pregnancy-associated relapse rate was 0.29 (95% CI, 0.04 to 2.18). The expected number of relapses in women with a recent pregnancy, given that they would experience the same relapse rate as that of women without a recent pregnancy, was 3.76; the observed-to-expected ratio was 0.27 (95% exact CI, 0.01 to 1.51).
  
  
  CONCLUSIONS
  We found no evidence that a pregnancy after diagnosis increases the relapse rate among women whose HL is in remission. Survivors of HL need to consider a range of factors when deciding about future reproduction. However, given the results of this study, the risk of pregnancy-associated relapse does not need to be considered.
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland. caroline.weibull@ki.se.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Weibull
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Eloranta
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Smedby
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
authors.forename: Magnus
authors.initials: M
authors.lastname: Björkholm
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
authors.forename: Sigurdur Y
authors.initials: SY
authors.lastname: Kristinsson
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
authors.forename: Anna L V
authors.initials: AL
authors.lastname: Johansson
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Dickman
authors.affiliation: Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Glimelius
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006689:Hodgkin Disease / Q000453:epidemiology*; D006801:Humans; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology*; D012008:Recurrence; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult