Risk of second malignancies in patients with early‐stage classical Hodgkin's lymphoma treated in a modern era

Abstract

Second malignancies remain an issue affecting morbidity and mortality in long-term survivors of early stage Hodgkin's lymphoma (HL). We undertook this study to determine if treatment in the modern era resulted in decreased second malignancies. Patients diagnosed with stage I–II cHL between 1988 and 2009 who received radiation therapy (RT) were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Freedom from second malignancy (FFSM) was estimated using the Kaplan–Meier method. Univariate analysis (UVA) was performed using the Log-Rank test, and included age, gender, year of diagnosis, and stage. Multivariable analysis (MVA) was performed using Cox Proportional Hazards modeling. The study cohort included 8807 patients. The median age at diagnosis was 32 years (range: 2–85). The majority of patients had stage II disease (n = 6044, 69%), 597 (7%) had extranodal involvement (ENI), and 1925 (22%) had B symptoms. Median follow-up for the entire cohort was 7.2 years (range: 0–22). Five hundred twenty-three (6%) patients developed a second malignancy. Median latency to second malignancy was 5.8 years (range: 0.1–21.5). Of the 523 patients that developed a second malignancy, 228 (44%) occurred in the first 5 years, 139 (27%) were diagnosed between years 5–10, and 156 (30%) beyond 10 years. The 10 year FFSM for patients treated between 1988 and 1999 was 93.0% versus 95.1% for patients treated between 2000 and 2009 (P = 0.04), On MVA, treatment between 2000 and 2009 was associated with a HR for second malignancy of 0.77 (95% Confidence Interval: 0.62–0.96, P = 0.02) compared to the treatment between 1988 and 1999. Our analysis suggests that in patients treated with RT for stage I or II cHL, treatment prior to 2000 had a slightly higher risk of second malignancy compared to treatment in 2000 and later. Further studies, with longer follow-up of patients treated in the modern era are needed to confirm these findings.

Canine small clear cell/T‐zone lymphoma: clinical presentation and outcome in a retrospective case series

“…This event has already been reported in dogs and people with lymphoma. The causes underlying the development of second malignancies are still unclear, but treatment, above all alkylating agents, has been associated with subsequent malignant neoplasms in human medicine . Two of three dogs developing second malignancy in this study had received alkylating chemotherapy.…”

Impact of Treatment and Insurance on Socioeconomic Disparities in Survival after Adolescent and Young Adult Hodgkin Lymphoma: A Population-Based Study

“…Our group and others (7, 12) also found that these disparities in treatment were associated with worse survival. Despite the survival benefits of radiation, this therapy has been associated with subsequent primary malignancies (6, 7, 21), an outcome that we were able to consider in our analyses. Specifically, we found that a somewhat higher proportion of patients who received radiation for their HL had subsequent cancer (4.9% versus 6.9%), which was associated with worse overall survival (data not shown); modern treatments with lower doses of radiation (7) may result in fewer subsequent cancers (21) and should continue to be monitored.…”

“…Despite the survival benefits of radiation, this therapy has been associated with subsequent primary malignancies (6, 7, 21), an outcome that we were able to consider in our analyses. Specifically, we found that a somewhat higher proportion of patients who received radiation for their HL had subsequent cancer (4.9% versus 6.9%), which was associated with worse overall survival (data not shown); modern treatments with lower doses of radiation (7) may result in fewer subsequent cancers (21) and should continue to be monitored. However, even after controlling for initial treatment and subsequent cancers, we still observed differences in survival by race/ethnicity, neighborhood SES and health insurance, suggesting that other factors are influencing these associations.…”

The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes

“…80 This might be advantageous in the commonly young female patients with PMBL since mediastinal radiotherapy has potentially serious late effects, such as cardiovascular disease, lung cancer, and breast cancer. 81 For patients with MGZL, DA-EPOCH-R treatment alone may not be sufficient since they more often required additional radiation to achieve long term complete remission than patients with PMBL. 80 …”