Sex-stratified risk of second malignancies in Hodgkin lymphoma survivors: A retrospective study.

e19041 Background: Hodgkin lymphoma (HL) survivors are at increased risk of second primary malignancies (SPMs), often related to treatment exposures such as radiation and chemotherapy. Understanding sex-specific and time-dependent patterns of SPMs is essential to guide survivorship care and improve long-term outcomes. Methods: Using SEER 12 Registries (1992–2021), we identified patients diagnosed with HL as a first primary malignancy. We applied SEER*Stat multiple primary–standardized incidence ratio (MP-SIR) sessions to calculate expected and observed cases of second malignancies. Outcomes were stratified by cancer type (solid vs hematologic), sex, and latency interval (10 years). We reported standardized incidence ratios (SIRs, O/E) with statistical significance determined by 95% confidence intervals. Results: Among HL survivors, the overall SIR for second malignancies was elevated across both sexes, with variation by cancer type and latency. Notably, Non-Hodgkin lymphoma exhibited persistently elevated and statistically significant observed-to-expected (O/E) ratios in both sexes across all latency periods, with particularly high risk within the first year post-Hodgkin lymphoma (M: 21.98, F: 26.51). Respiratory system cancers also showed consistently elevated risks (e.g., M: 2.44, F: 6.26 at & 10 years (F: 1.80). Sex-specific differences were evident in several cancers, including urinary system, melanoma, and thyroid, where females generally exhibited higher O/E ratios. These findings highlight the importance of both latency and sex in tailoring surveillance strategies for Hodgkin lymphoma survivors. Conclusions: This analysis highlights the importance of sex- and latency-specific surveillance strategies in HL survivorship care. Early vigilance for hematologic malignancies and long-term screening for radiation-associated solid tumors, is warranted. These findings support risk-adapted follow-up and inform guideline development for survivorship clinics.