Second Malignant Neoplasms After Treatment for Hodgkin’s Disease in Childhood or Adolescence

Green, D M; Hyland, Andrew; Barcos, Maurice; Reynolds, Julie A.; Lee, R J; Hall, Brenda; Zevon, Michael A.

doi:10.1200/jco.2000.18.7.1492

Cited by 133 publications

(74 citation statements)

References 39 publications

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“…36,37 Others have shown a high risk of secondary NHL in the first year after treatment initiation, which declines in the next 5 years, and peaks in the subsequent 10 to 14 years, 37,38 but might continue to occur in patients having long follow-ups. Green et al 39 reported a cumulative incidence of 4.62% for secondary NHL 30 years after diagnosis of nodular sclerosing HL. Van Leeuwen, 37 however, observed the highest incidence of 5.9% AE 2.1% in 744 patients with HL, at a median interval of 13.3 years between HL diagnosis and secondary NHL.…”

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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“…8 Cohorts of Hodgkin's patients of any stage suggest that this difference is much higher. 8,[11][12][13][14][15][16][17]39 However, patients who relapse have a more pronounced risk of secondary malignancies according to a cohort study by Aleman and colleagues. 16 Therefore, the addition of radiotherapy which reduces the number of patients with relapse (who require more aggressive therapy) may contribute to a smaller overall risk difference than suggested by the cohorts who do not distinguish between relapsed and non-relapsed patients when evaluating the risk of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…8,11 Risk factors for secondary malignancies and cardiac disease are the choice and dose of chemotherapy and radiotherapy. 8,[11][12][13][14][15][16][17] Unfortunately, long-term comparisons of combined modality treatment with chemotherapy alone (CT-alone) are difficult in cohorts of Hodgkin's survivors. Nonetheless, to avoid additional radiation-induced toxicity, chemotherapy-only treatment for patients with early stage HL has been advocated.…”

Section: Introductionmentioning

confidence: 99%

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Herbst¹,

Rehan²,

Brillant³

et al. 2009

Haematologica

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The online version of this article has a supplementary appendix.Combined modality treatment (CMT) of chemotherapy followed by localized radiotherapy is standard treatment for patients with early stage Hodgkin's lymphoma. However, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. We thus performed a systematic review with meta-analysis of randomized controlled trials comparing chemotherapy alone with CMT in patients with early stage Hodgkin's lymphoma with respect to response rate, tumor control and overall survival (OS). We searched Medline, EMBASE and the Cochrane Library as well as conference proceedings from January 1980 to February 2009 for randomized controlled trials comparing chemotherapy alone versus the same chemotherapy regimen plus radiotherapy. Progression free survival and similar outcomes were analyzed together as tumor control. Effect measures used were hazard ratios for OS and tumor control as well as relative risks for complete response (CR). Meta-analyses were performed using RevMan5. Five randomized controlled trials involving 1,245 patients were included. The hazard ratio (HR) was 0.41 (95% confidence interval (CI) 0.25 to 0.66) for tumor control and 0.40 (95% CI 0.27 to 0.59) for OS for patients receiving CMT compared to chemotherapy alone. CR rates were similar between treatment groups. In sensitivity analyses another 6 trials were included that did not fulfill the inclusion criteria of our protocol but were considered relevant to the topic. These trials underlined the results of the main analysis. In conclusion, adding radiotherapy to chemotherapy improves tumor control and OS in patients with early stage Hodgkin's lymphoma.Key words: combined modality treatment, chemotherapy, Hodgkin's lymphoma.Citation: Herbst C, Rehan FA, Brillant C, Bohlius J, Skoetz N, Schulz H, Monsef I, Specht L, and Engert A. Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review. Haematologica. 2010.95:494-500. doi:10.3324/haematol.2009 This is an open-access paper. ABSTRACT therapy.The main objective of this systematic review was to compare chemotherapy alone with identical chemotherapy plus radiotherapy in patients with early stage HL with respect to overall survival, tumor control and complete response rates.

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“…In a recent report, 28 of 182 former patients with Hodgkin's disease during childhood or adolescence were identi® ed with a SMN (18). We recognized a SMN in four patients (3%) during the observation period.…”

Section: Discussionmentioning

confidence: 99%