Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1990 Nov 10;301(6760):1077–1080. doi: 10.1136/bmj.301.6760.1077

Leukaemia complicating treatment for Hodgkin's disease: the experience of the British National Lymphoma Investigation.

S Devereux 1, T G Selassie 1, G Vaughan Hudson 1, B Vaughan Hudson 1, D C Linch 1
PMCID: PMC1664202  PMID: 2249071

Abstract

OBJECTIVE--To determine the incidence of and risk factors for the development of secondary acute leukaemia and myelodysplasia in patients treated in British National Lymphoma Investigation's studies of Hodgkin's disease since 1970. PATIENTS--2676 Patients entered into Hodgkin's disease studies between February 1970 and November 1986. Data accrued up to November 1988 were analysed, ensuring a minimum follow up period of two years. DESIGN--Retrospective analysis of multicentre trial data by case-control and life table methods. RESULTS--17 Cases of secondary leukaemia were recorded in this group of 2676 patients, giving an overall risk at 15 years of 1.7%. The risks of leukaemia after chemotherapy alone and chemotherapy with radiotherapy were not significantly different. The risk of leukaemia increased sharply with the amount of treatment given as measured by the number of attempts at treatment. The 15 year risks of leukaemia were 0.2%, 2.3%, and 8.1% for patients receiving one, two, or three or more attempts at treatment. The highest risk, 22.8% at 15 years, was observed in patients treated with lomustine (CCNU), and a case-control study suggested that this was an independent risk factor. The risk of secondary leukaemia was largely related to the overall quantity of treatment, although exposure to lomustine seemed to be an important risk factor. Treatment with both drugs and radiation was not more leukaemogenic than treatment with drugs alone. The greatest risk of secondary leukaemia was seen in multiply treated patients who were unlikely to be cured of Hodgkin's disease. CONCLUSIONS--Avoidance of secondary leukaemia should be a minor factor in the choice of treatment for Hodgkin's disease.

Full text

PDF
1077

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aisenberg A. C. Acute nonlymphocytic leukemia after treatment for Hodgkin's disease. Am J Med. 1983 Sep;75(3):449–454. doi: 10.1016/0002-9343(83)90348-0. [DOI] [PubMed] [Google Scholar]
  2. Arseneau J. C., Sponzo R. W., Levin D. L., Schnipper L. E., Bonner H., Young R. C., Canellos G. P., Johnson R. E., DeVita V. T. Nonlymphomatous malignant tumors complicating Hodgkin's disease. Possible association with intensive therapy. N Engl J Med. 1972 Nov 30;287(22):1119–1122. doi: 10.1056/NEJM197211302872204. [DOI] [PubMed] [Google Scholar]
  3. Baccarani M., Bosi A., Papa G. Second malignancy in patients treated by Hodgkin's disease. Cancer. 1980 Oct 15;46(8):1735–1740. doi: 10.1002/1097-0142(19801015)46:8<1735::aid-cncr2820460806>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  4. Bennett J. M., Catovsky D., Daniel M. T., Flandrin G., Galton D. A., Gralnick H. R., Sultan C. Criteria for the diagnosis of acute leukemia of megakaryocyte lineage (M7). A report of the French-American-British Cooperative Group. Ann Intern Med. 1985 Sep;103(3):460–462. doi: 10.7326/0003-4819-103-3-460. [DOI] [PubMed] [Google Scholar]
  5. Bennett J. M., Catovsky D., Daniel M. T., Flandrin G., Galton D. A., Gralnick H. R., Sultan C. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982 Jun;51(2):189–199. [PubMed] [Google Scholar]
  6. Blayney D. W., Longo D. L., Young R. C., Greene M. H., Hubbard S. M., Postal M. G., Duffey P. L., DeVita V. T., Jr Decreasing risk of leukemia with prolonged follow-up after chemotherapy and radiotherapy for Hodgkin's disease. N Engl J Med. 1987 Mar 19;316(12):710–714. doi: 10.1056/NEJM198703193161203. [DOI] [PubMed] [Google Scholar]
  7. Boice J. D., Jr, Greene M. H., Killen J. Y., Jr, Ellenberg S. S., Keehn R. J., McFadden E., Chen T. T., Fraumeni J. F., Jr Leukemia and preleukemia after adjuvant treatment of gastrointestinal cancer with semustine (methyl-CCNU). N Engl J Med. 1983 Nov 3;309(18):1079–1084. doi: 10.1056/NEJM198311033091802. [DOI] [PubMed] [Google Scholar]
  8. Coleman C. N., Williams C. J., Flint A., Glatstein E. J., Rosenberg S. A., Kaplan H. S. Hematologic neoplasia in patients treated for Hodgkin's disease. N Engl J Med. 1977 Dec 8;297(23):1249–1252. doi: 10.1056/NEJM197712082972303. [DOI] [PubMed] [Google Scholar]
  9. Coltman C. A., Jr, Dixon D. O. Second malignancies complicating Hodgkin's disease: a Southwest Oncology Group 10-year followup. Cancer Treat Rep. 1982 Apr;66(4):1023–1033. [PubMed] [Google Scholar]
  10. Glicksman A. S., Pajak T. F., Gottlieb A., Nissen N., Stutzman L., Cooper M. R. Second malignant neoplasms in patients successfully treated for Hodgkin's disease: a Cancer and Leukemia Group B study. Cancer Treat Rep. 1982 Apr;66(4):1035–1044. [PubMed] [Google Scholar]
  11. Grünwald H. W., Rosner F. Acute myeloid leukemia following treatment of Hodgkin's disease: a review. Cancer. 1982 Aug 15;50(4):676–683. doi: 10.1002/1097-0142(19820815)50:4<676::aid-cncr2820500410>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  12. Kaldor J. M., Day N. E., Clarke E. A., Van Leeuwen F. E., Henry-Amar M., Fiorentino M. V., Bell J., Pedersen D., Band P., Assouline D. Leukemia following Hodgkin's disease. N Engl J Med. 1990 Jan 4;322(1):7–13. doi: 10.1056/NEJM199001043220102. [DOI] [PubMed] [Google Scholar]
  13. LACHER M. J., SUSSMAN L. N. LEUKEMIA AND HODGKIN'S DISEASE. Ann Intern Med. 1963 Sep;59:369–378. doi: 10.7326/0003-4819-59-3-369. [DOI] [PubMed] [Google Scholar]
  14. Levine E. G., Bloomfield C. D. Secondary myelodysplastic syndromes and leukaemias. Clin Haematol. 1986 Nov;15(4):1037–1080. [PubMed] [Google Scholar]
  15. Papa G., Mauro F. R., Anselmo A. P., Cimino G., Alimena G., Amadori S., D'Arcangelo E., Giannarelli D., Bosi A., Bellesi G. Acute leukaemia in patients treated for Hodgkin's disease. Br J Haematol. 1984 Sep;58(1):43–52. doi: 10.1111/j.1365-2141.1984.tb06057.x. [DOI] [PubMed] [Google Scholar]
  16. Pedersen-Bjergaard J., Larsen S. O. Incidence of acute nonlymphocytic leukemia, preleukemia, and acute myeloproliferative syndrome up to 10 years after treatment of Hodgkin's disease. N Engl J Med. 1982 Oct 14;307(16):965–971. doi: 10.1056/NEJM198210143071601. [DOI] [PubMed] [Google Scholar]
  17. Tester W. J., Kinsella T. J., Waller B., Makuch R. W., Kelley P. A., Glatstein E., DeVita V. T. Second malignant neoplasms complicating Hodgkin's disease: the National Cancer Institute experience. J Clin Oncol. 1984 Jul;2(7):762–769. doi: 10.1200/JCO.1984.2.7.762. [DOI] [PubMed] [Google Scholar]
  18. Tucker M. A., Coleman C. N., Cox R. S., Varghese A., Rosenberg S. A. Risk of second cancers after treatment for Hodgkin's disease. N Engl J Med. 1988 Jan 14;318(2):76–81. doi: 10.1056/NEJM198801143180203. [DOI] [PubMed] [Google Scholar]
  19. Valagussa P., Santoro A., Fossati-Bellani F., Banfi A., Bonadonna G. Second acute leukemia and other malignancies following treatment for Hodgkin's disease. J Clin Oncol. 1986 Jun;4(6):830–837. doi: 10.1200/JCO.1986.4.6.830. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES