Second Cancers Among Long-Term Survivors of Hodgkin’s Disease Diagnosed in Childhood and Adolescence

Metayer, Catherine; Lynch, Charles F.; Clarke, E. Aileen; Glimelius, Bengt; Storm, Hans; Pukkala, Eero; Joensuu, Timo; Leeuwen, Flora E. van; Veer, M. B. Van't; Curtis, Rochelle E.; Holowaty, Eric J.; Andersson, Michael; Wıklund, Tom; Gospodarowicz, Mary K.; Travis, Lois B.

doi:10.1200/jco.2000.18.12.2435

Cited by 314 publications

(193 citation statements)

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“…2,18,19 It also demonstrates that the incidence, risk trends, and outcome of childhood cancer survivors who develop secondary hematological malignancies vary by primary cancer type and treatment periods.…”

Section: Discussionmentioning

confidence: 99%

Secondary hematopoietic malignancies in survivors of childhood cancer

Rihani

Bazzeh

Faqih

et al. 2010

Cancer

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BACKGROUND: Studying secondary hematological malignancies in a large cohort of patients can help predict risks and trends associated with current therapies. METHODS: The authors analyzed data from the Surveillance, Epidemiology, and End Resultsecondary 9 (SEER-9) database on patients with a primary malignancy (diagnosed before the age of 20 years) between 1973 and 2005 who developed a secondary hematological malignancy. Primary cancer and histological subtype, incidence, risk factors, outcomes, and changes in risk patterns of secondary hematological malignancies were analyzed for 1973 to 1985, 1986 to 1995, and 1996 to 2005. Standardized incidence ratios (SIRs) of observed to expected cancers were calculated. RESULTS: Of 34,867 patients with a histology-confirmed primary malignancy, 111 developed secondary hematological malignancies (median, 44 months). Lymphoma was the commonest primary cancer (n ¼ 47). The main histological subtype of secondary hematological malignancy was acute myeloid leukemia (AML) (49%), which had the shortest median latency time and the worst 5-year survival (18% AE 5.3%; P ¼.044). Secondary Hodgkin lymphoma had the best 5-year survival (83% AE 15%). The 5-year overall survival for patients with secondary hematological malignancies was 31% AE 4.7%. The risk of secondary AML steadily increased from 1986 to 2005, whereas SIRs for acute lymphoblastic leukemia did not change over time. Non-Hodgkin lymphoma, the second most common secondary hematological malignancy, occurred at a median of 112 months, and its risk steadily increased over time periods. CONCLUSIONS: Childhood cancer survivors are at increased risk of developing secondary hematological malignancies, particularly secondary AML. This risk has continued to rise even in recent years, emphasizing the need to study other factors contributing to secondary hematological malignancies and closely monitor these patients. Cancer 2010;116:4385-94.

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Section: Discussionmentioning

confidence: 99%

Secondary hematopoietic malignancies in survivors of childhood cancer

Rihani

Bazzeh

Faqih

et al. 2010

Cancer

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“…After childhood or adolescent treatment, however, induction periods appear to be shorter (Bhatia et al, 1996b;Sankila et al, 1996;Travis et al, 1996;Metayer et al, 2000), indeed as short as within the first 5 years in one study (Bhatia et al, 1996b).…”

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confidence: 87%

“…How long the risks remain raised is as yet unknown, because of the limited length of follow-up yet available in published studies. Several groups have presented data for 20 and more years of follow-up, finding large and significant relative risks of breast cancer for this time period (Hancock et al, 1993;Bhatia et al, 1996b;Wolden et al, 1998;Metayer et al, 2000;van Leeuwen et al, 2000). One study has published cohort results for 25 and more years, again with a significantly raised risk (Dores et al, 2002) (in a case -control study with no general population comparison, the risk was nonsignificantly raised at 25 and more years for radiation-exposed women (Travis et al, 2003)).…”

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confidence: 99%

“…For patients treated under age 21 years relative risks have generally been around 15 -25 (Hancock et al, 1993;Sankila et al, 1996;Wolden et al, 1998;Metayer et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002), although they have been less raised (Neglia et al, 2001) or more raised (Mauch et al, 1996;Bhatia et al, 1996b;Aisenberg et al, 1997;Ng et al, 2002b) than this in a few studies; absolute excess risks have generally been of the order of 20 -40 per 10 000 per annum. Relative risks have been greater for patients treated at ages 10 -16 than at younger or older ages (Hancock et al, 1993;Sankila et al, 1996;Bhatia et al, 1996b;Metayer et al, 2000). Differences between study results partly reflect differences in distributions of age at treatment, radiation dosage and duration of follow-up, but also caution must be exercised in interpretation of studies such as that by Bhatia (Bhatia et al, 1996b), where follow-up to a fixed end-date is incomplete.…”

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confidence: 99%

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Second primary breast cancer after Hodgkin's disease

Horwich

Swerdlow

2004

Br J Cancer

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Although the potential carcinogenic risk of radiotherapy is well known, it has become clear that there is a particularly high risk of radiation-induced breast cancer in women treated for Hodgkin's disease at young ages. Thankfully, death from breast cancer in this population is uncommon, but it is important to understand factors contributing to the risk, including treatment parameters, and to develop a logical and efficient method for medical management of those at risk. In this minireview, we examine the evidence which should inform such a management policy. The prognosis of patients with Hodgkin's disease has been improved dramatically over the last 40 years by the development of extended field radiotherapy techniques and then by combination chemotherapy (DeVita et al, 1980;Rosenberg and Kaplan, 1985). However, long-term follow-up of survivors has demonstrated that a price of this success has been an increased risk of second cancers. Acute leukaemia frequently occurs in the first decade after treatment, mainly as a consequence of chemotherapy regimens that included an alkylating agent (Tucker et al, 1988;Kaldor et al, 1990;Swerdlow et al, 2000). In the long term, however, the absolute excess risks of a second solid cancer are higher (Swerdlow et al, 2000;Ng et al, 2002b; and are linked mainly with radiotherapy, although for some sites, such as lung cancer, there may be a substantial risk also from chemotherapy (Swerdlow et al, 2000;Travis et al, 2002). Recent reports from The Netherlands and from an international consortium of cancer registries have refined our understanding of how therapy may affect breast cancer risk.The relative risks of many cancers are higher if patients have been treated for Hodgkin's disease at a younger age (Swerdlow et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002). Thus, although the risk of breast cancer is only about 50% increased in most all-age studies of women with Hodgkin's disease (van Leeuwen et al, 1999), relative risks are far larger than this in patients treated at young ages, especially those treated in childhood and adolescence (Hancock et al, 1993;Bhatia et al, 1996b); for them this is one of the main long-term sequelae of radiotherapy. This effect of age is unsurprising, as similar gradients are seen in other cohorts of radiation-exposed women (United Nations Scientific Committee on the Effects of Atomic Radiation, 1994).The size of risk of breast cancer found in Hodgkin's disease patients has varied between studies. For patients treated under age 21 years relative risks have generally been around 15 -25 (Hancock et al, 1993;Sankila et al, 1996;Wolden et al, 1998;Metayer et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002), although they have been less raised (Neglia et al, 2001) or more raised (Mauch et al, 1996;Bhatia et al, 1996b;Aisenberg et al, 1997;Ng et al, 2002b) than this in a few studies; absolute excess risks have generally been of the order of 20 -40 per 10 000 per annum. Relative risks have been greater for patients treated at ages 10 -16 than at...

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“…This is offset by increased risk for developing second primary cancers, infections and cardiovascular disease [78], [79], [80] and [81]. The main cause of death remains disease itself but after 20 years this is negligible [82].…”

Section: Long-term Complicationsmentioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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Second Cancers Among Long-Term Survivors of Hodgkin’s Disease Diagnosed in Childhood and Adolescence

Cited by 314 publications

References 52 publications

Secondary hematopoietic malignancies in survivors of childhood cancer

Secondary hematopoietic malignancies in survivors of childhood cancer

Second primary breast cancer after Hodgkin's disease

Human immunodeficiency and Hodgkin lymphoma

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