Dear Dr. Dezube,

I read your response to a reader's March 31 question in which you answered that the predisposition to other cancers after Hodgkin's disease is a result of the ability of Hodgkin's disease to impair the immune system. Is this increased risk lifelong? Is it a different part of the immune system than is measured by CD4 counts? I was diagnosed with Hodgkin's in 12/98 and went through 4 cycles of ABVD. I responded remarkbaly well and the tumor disappeared after only 2.5 cycles. I finished the treatment anyway and have been cancer free since April 1999. Latest CD4 is 707 and VL has consistenly been <50. Am I still at increased risk for other types of cancers? If so, why is that the case with such good CD4 levels? Thanks for your help!

Your question is a very valid one. You want to know why you would be at increased risk for other cancers when your CD4 cell count is so robust. ALL patients with Hodgkin's disease are at increased risk for cancer whether they are HIV positive or negative. There are many reasons for this.

1) Both chemotherapy and radiation therapy effectively treat Hodgkin's disease. Unfortunately these treatments also cause mutations to otherwise health cells. In time, these mutations can lead to new cancers.

2) Hodgkin's disease does indeed cause defects in the immune system INDEPENDENT of CD4 cell counts. Such defects in the immune system also predispose individuals to cancer. Please realize that CD4 cells are an important marker of the immune system. A CD4 cell count, however, does not tell the whole story.

The most important step which Hodgkin's disease-survivors can take is to stop smoking if they are smoking. Another important step is to minimize sun exposure to prevent skin cancers. Woman, who may have had their breasts exposured to radiation during the course of their therapy, need to be particularly closely watched. The smoking issue is sooooo important because as hard as it is to swallow a diagnosis of Hodgkin's disease, it is even harder to deal with a lung cancer diagnosis.

One very important final point-- All the comments in the above paragraph apply to both HIV-positive and HIV-negative patients. For those of you who are HIV-positive, it is essential that you stay on your HIV medications! If you come off your HIV medications (e.g. prolonged drug holiday), then you greatly increase your chance of the Hodgkin's disease coming back.

Although much of what I have written in the above response may not be pleasant to hear (Who wants to hear that they may get a new cancer??), knowledge is power. It is good to know the enemy (in this case cancer) and to do everything in your power to prevent a new cancer, as well as to diagnosis it early.