Occurrence of Non-Hodgkin's Lymphoma after Therapy for Hodgkin's Disease

Abstract

We studied the clinical and pathological features of six cases of non-Hodgkin's lymphoma (diffuse undifferentiated in four cases and diffuse histiocytic in two cases) occuring in patients treated for Hodgkin's disease. All six patients had received both radiation and chemotherapy. Abdominal or gastrointestinal involvement was present in five of the six cases. None of the patients had evidence of Hodgkin's disease when the diagnosis of non-Hodgkin's lymphoma was made. Five of the six patients were among a study group of 579 patients with Hodgkin's disease, prospectively followed since diagnosis. At 10 years the actuarial risk of development of non-Hodgkin's lymphoma in this study group is 4.4 per cent (1.2 to 15.0) (per cent probability with 95 per cent confidence limits) and is similar to that of developing acute leukemia: 2.0 per cent (0.3 to 12.9). Non-Hodgkin's lymphoma is a second tumor that may occur late in the course of patients treated for Hodgkin's disease--particularly in patients who have received both radiation therapy and chemotherapy. Like acute leukemia, non-Hodgkin's lymphoma may be another cancer that represents a substantial late risk of combined-modality therapy.

The non-Hodgkin lymphomas: A review of the epidemiologic literature

“…61 Increased risk of NHL following a prior diagnosis of HL and therapy for HL have been documented. 465,642,643 The risk of developing NHL among persons treated for HL was 0.3% after 5 years, and 4.4% after 10 years. 643 An increased risk of developing NHL following a diagnosis of breast cancer was reported in a cohort study of Japanese women (RR 5 3.5, 95% CI: 1.4-7.1).…”

“…465,642,643 The risk of developing NHL among persons treated for HL was 0.3% after 5 years, and 4.4% after 10 years. 643 An increased risk of developing NHL following a diagnosis of breast cancer was reported in a cohort study of Japanese women (RR 5 3.5, 95% CI: 1.4-7.1). 644 Wassberg et al 645,646 evaluated the subsequent risk of NHL among persons diagnosed with squamous cell carcinoma (SCC) of the skin or cutaneous malignant melanoma (CMM).…”

U‐2940, a human B‐cell line derived from a diffuse large cell lymphoma sequential to Hodgkin lymphoma

“…[1][2][3] In this context, the disease-free interval is frequently longer than 5 years, the DLBCL is similar to B-cell malignancies arising in immunocompromised patients and both genotoxicity and immune deficiency are considered to be involved in lymphoma development. However, other forms of association between HL and nonHodgkin lymphomas (NHL) that suggest an interrelationship between both diseases have long been recognized.…”

Survivorship in Hodgkin Lymphoma

“…[21,33,34] The risk appears to be influenced by the selection of treatment, with alkylator therapy and radiotherapy emerging as the likely causes of oncogenesis. Estimates of the relative risk of NHL among survivors of HL are varied across reports, ranging from 2 to 22, but the absolute risks are low: The 25-year cumulative risk of NHL is less than 4%, and the absolute excess risk (AER) of NHL is less than 10 cases per 10,000 person-years.…”