An affair of the heart.

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Abstract
In 1950, patients with Hodgkin lymphoma had a median survival time of 4 years and a 5-year relative survival rate of 29% ( 1 ). Since the introduction of radiation therapy and chemotherapy for Hodgkin lymphoma in the 1960s and 1970s, the 5-year relative survival rate is more than 85% ( 2 ), and these patients can now expect a long lymphoma-free life. However, the price for this phenomenal success has been high. “Radiation-induced heart disease” was recognized in the 1960s ( 3 ) and radiation-induced cancers somewhat later ( 4 – 6 ). Multidrug chemotherapy was introduced in the 1970s (i.e., combination chemotherapy with mechlorethamine, vincristine, procarbazine, and prednisone) ( 7 ); however, one of these drugs, nitrogen mustard (mechlorethamine), appeared to carry a high risk of leukemia ( 8 ). Over the years, other drug combinations that were equally effective but less leukemogenic were introduced, such as doxorubicin, bleomycin, vinblastine, and dacarbazine. Unfortunately, the anthracycline doxorubicin carried an increased risk of cardiac toxicity ( 9 ). In a sense, one type of late effect, leukemia, was being replaced by another, heart disease.

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