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WE IDENTIFIED IS SECOND MALIGNANCIES (11 cases of acute myelogenous leukemia and seven other tumors) among 643 patients with all stages of Hodgkin's disease treated by members of the Southwest Oncology Group (SWOG) on three concurrently run protocols. The expected number of second malignancies, based on age, sex, and person years of observation, is 1.85, for an incidence density ratio of 10.33 (P < 0.05). The incidence density ratio is 3.81 for other tumors and 302.45 for acute myelogenous leukemia. When considered with respect to intensity of therapy administered, the incidence density ratio for other tumors did not exceed 7.55. The incidence density ratio of acute leukemia varies from 256.67 for patients receiving intensive chemotherapy to 1048.73 for patients receiving combined intensive radiotherapy and intensive chemotherapy. These data support the concept that patients treated for Hodgkin's disease are at highly increased risk to develop a second malignancy, that the increase is primarily due to patients developing AML, and that there is a correlation with intensity of treatment (P < 0.01).