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. 1992 May 2;304(6835):1137–1143. doi: 10.1136/bmj.304.6835.1137

Risk of second primary cancers after Hodgkin's disease by type of treatment: analysis of 2846 patients in the British National Lymphoma Investigation.

A J Swerdlow 1, A J Douglas 1, G V Hudson 1, B V Hudson 1, M H Bennett 1, K A MacLennan 1
PMCID: PMC1882078  PMID: 1392790

Abstract

OBJECTIVE--To analyse the risk of second primary cancers during long term follow up of patients with Hodgkin's disease. DESIGN--Cohort study. SETTING--The British National Lymphoma Investigation (a collaborative group of over 60 participating centres in Britain treating lymphomas). PATIENTS--2846 patients first treated for Hodgkin's disease during 1970-87, for whom follow up was complete in 99.8%. MAIN OUTCOME MEASURES--Second primary cancers; uniform pathology reviews confirmed the diagnosis of Hodgkin's disease and of second primary non-Hodgkin's lymphomas. RESULTS--113 second primary cancers occurred. Relative risk of cancer other than Hodgkin's disease was 2.7 (95% confidence interval 2.3 to 3.3) compared with the general population, with significant risk of leukaemia (16.0(9.1 to 26.0)); non-Hodgkin's lymphoma (16.8(9.8 to 26.9)); and cancers of the colon (3.2 (1.4 to 6.2)), lung (3.8 (2.6 to 5.4)), bone (15.1 (1.8 to 54.7)), and thyroid (9.4 (1.1 to 33.9)). Absolute excess risk associated with treatment was greater for solid tumours than for leukaemia and lymphomas. Relative risk of leukaemia increased soon after treatment, reaching a peak after five to nine years. It was increased substantially after chemotherapy (27.9 (12.7 to 52.9)), combined treatment with radiotherapy and chemotherapy (21.5 (7.9 to 46.8)), and relative to number of courses of chemotherapy but was not significantly increased after radiotherapy (2.5 (0.1 to 14.1)). Relative risk of non-Hodgkin's lymphoma increased in the first five years after treatment and remained high but showed no clear relation with type or extent of treatment. Relative risk of solid tumours was less raised initially but increased throughout follow up and for lung cancer 10 years or more after entry was 8.3 (4.0 to 15.3). The risk of solid tumours increased after treatments including radiotherapy and after chemotherapy alone. The risk after chemotherapy increased significantly with time since first treatment. CONCLUSION--The risk of solid cancer, not of leukaemia, is the major long term hazard of treatment for Hodgkin's disease, and this seemed to apply after chemotherapy as well as after radiotherapy. These risks of second cancers are important in choice of treatment and in follow up of patients, but they are small compared with the great improvements in survival which have been brought about by modern therapeutic methods for Hodgkin's disease.

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Selected References

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  1. Bennett M. H., MacLennan K. A., Vaughan Hudson G., Vaughan Hudson B. Non-Hodgkin's lymphoma arising in patients treated for Hodgkin's disease in the BNLI: a 20-year experience. British National Lymphoma Investigation. Ann Oncol. 1991 Feb;2 (Suppl 2):83–92. doi: 10.1093/annonc/2.suppl_2.83. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Boivin J. F., Hutchison G. B., Lyden M., Godbold J., Chorosh J., Schottenfeld D. Second primary cancers following treatment of Hodgkin's disease. J Natl Cancer Inst. 1984 Feb;72(2):233–241. [PubMed] [Google Scholar]
  4. Boivin J. F., O'Brien K. Solid cancer risk after treatment of Hodgkin's disease. Cancer. 1988 Jun 15;61(12):2541–2546. doi: 10.1002/1097-0142(19880615)61:12<2541::aid-cncr2820611225>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Coleman M., Douglas A., Hermon C., Peto J. Cohort study analysis with a FORTRAN computer program. Int J Epidemiol. 1986 Mar;15(1):134–137. doi: 10.1093/ije/15.1.134. [DOI] [PubMed] [Google Scholar]
  7. Colman M., Easton D. F., Horwich A., Peckham M. J. Second malignancies and Hodgkin's disease--the Royal Marsden Hospital experience. Radiother Oncol. 1988 Mar;11(3):229–238. doi: 10.1016/0167-8140(88)90005-9. [DOI] [PubMed] [Google Scholar]
  8. Devereux S., Selassie T. G., Vaughan Hudson G., Vaughan Hudson B., Linch D. C. Leukaemia complicating treatment for Hodgkin's disease: the experience of the British National Lymphoma Investigation. BMJ. 1990 Nov 10;301(6760):1077–1080. doi: 10.1136/bmj.301.6760.1077. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hancock B. W., Vaughan Hudson G., Vaughan Hudson B., Haybittle J. L., Bennett M. H., MacLennan K. A., Jelliffe A. M. British National Lymphoma Investigation randomised study of MOPP (mustine, Oncovin, procarbazine, prednisolone) against LOPP (Leukeran substituted for mustine) in advanced Hodgkin's disease--long term results. Br J Cancer. 1991 Apr;63(4):579–582. doi: 10.1038/bjc.1991.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Henry-Amar M. Quantitative risk of second cancer in patients in first complete remission from early stages of Hodgkin's disease. NCI Monogr. 1988;(6):65–72. [PubMed] [Google Scholar]
  11. Kaldor J. M., Day N. E., Band P., Choi N. W., Clarke E. A., Coleman M. P., Hakama M., Koch M., Langmark F., Neal F. E. Second malignancies following testicular cancer, ovarian cancer and Hodgkin's disease: an international collaborative study among cancer registries. Int J Cancer. 1987 May 15;39(5):571–585. doi: 10.1002/ijc.2910390506. [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. Pedersen-Bjergaard J., Specht L., Larsen S. O., Ersbøll J., Struck J., Hansen M. M., Hansen H. H., Nissen N. I. Risk of therapy-related leukaemia and preleukaemia after Hodgkin's disease. Relation to age, cumulative dose of alkylating agents, and time from chemotherapy. Lancet. 1987 Jul 11;2(8550):83–88. doi: 10.1016/s0140-6736(87)92744-9. [DOI] [PubMed] [Google Scholar]
  14. Polednak A. P., Stehney A. F., Rowland R. E. Mortality among women first employed before 1930 in the U.S. radium dial-painting industry. A group ascertained from employment lists. Am J Epidemiol. 1978 Mar;107(3):179–195. doi: 10.1093/oxfordjournals.aje.a112524. [DOI] [PubMed] [Google Scholar]
  15. Selby P., Patel P., Milan S., Meldrum M., Mansi J., Mbidde E., Brada M., Perren T., Forgeson G., Gore M. ChlVPP combination chemotherapy for Hodgkin's disease: long-term results. Br J Cancer. 1990 Aug;62(2):279–285. doi: 10.1038/bjc.1990.278. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Smith P. G., Doll R. Mortality from cancer and all causes among British radiologists. Br J Radiol. 1981 Mar;54(639):187–194. doi: 10.1259/0007-1285-54-639-187. [DOI] [PubMed] [Google Scholar]
  17. Smith P. G. Leukemia and other cancers following radiation treatment of pelvic disease. Cancer. 1977 Apr;39(4 Suppl):1901–1905. doi: 10.1002/1097-0142(197704)39:4+<1901::aid-cncr2820390826>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  18. 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]
  19. 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]
  20. 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]
  21. Young R. C., Bookman M. A., Longo D. L. Late complications of Hodgkin's disease management. J Natl Cancer Inst Monogr. 1990;(10):55–60. [PubMed] [Google Scholar]
  22. van Leeuwen F. E., Somers R., Taal B. G., van Heerde P., Coster B., Dozeman T., Huisman S. J., Hart A. A. Increased risk of lung cancer, non-Hodgkin's lymphoma, and leukemia following Hodgkin's disease. J Clin Oncol. 1989 Aug;7(8):1046–1058. doi: 10.1200/JCO.1989.7.8.1046. [DOI] [PubMed] [Google Scholar]
  23. van Rijswijk R. E., Sybesma J. P., Kater L. A prospective study of the changes in immune status following radiotherapy for Hodgkin's disease. Cancer. 1984 Jan 1;53(1):62–69. doi: 10.1002/1097-0142(19840101)53:1<62::aid-cncr2820530112>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]

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