Risk of Secondary Acute Leukemia and Preleukemia After Hodgkin’s Disease: The Institut Gustave-Roussy Experience

Henry-Amar, Michel; Pellae-Cosset, B.; Bayle-Weisgerber, C; Hayat, M.; Cosset, Jean‐Marc; Carde, Patrice; Tubiana, M

doi:10.1007/978-3-642-83781-4_30

Cited by 26 publications

(6 citation statements)

References 28 publications

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“…As in several previous analyses (Pedersen-Bjegaard et al, 1987;van der Velden et al, 1988;Henri-Amar et al, 1989;Kaldor et al, 1990;van Leeuwen et al, 1994b), risk of leukaemia increased dramatically with dose or number of cycles of treatment and, indeed, there were no leukaemias in the present study in patients treated with only six cycles (one standard course) or less. As the high risk of leukaemia after chemotherapy became clear, various alternatives to the most used original combination, MOPP, have been introduced, which might lead to a lower risk of leukaemia, but studies have often had too few patients with any particular other treatment to divide their analyses further than MOPP and 'other' chemotherapy.…”

Section: Discussionsupporting

confidence: 86%

Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Swerdlow

Barber²,

Horwich³

et al. 1997

Br J Cancer

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Summary Risk of second primary malignancy was assessed in follow-up to June 1991 of 1039 patients first treated for Hodgkin's disease at the Royal Marsden Hospital during 1963-91. A total of 77 second malignancies occurred. There were significantly raised risks of stomach [standardized incidence ratio (SIR)=4.0], lung (SIR=3.8), bone (SIR=26.5), soft tissue (SIR=1 6.9) and non-melanoma skin (SIR=3.9) cancers, non-Hodgkin's lymphoma (SIR=4.6), and acute and non-lymphocytic leukaemia (SIR=31.3), with a relative risk of 3.3 for all second cancers other than non-melanoma skin cancer. Solid cancer risk was raised to a similar extent in patients treated only with radiotherapy (SIR=2.6, P<0.001), only with chemotherapy (SIR=2.1, P=0.08) and with both (SIR=3.1, P<0.001). Leukaemia risk was raised only in those receiving chemotherapy, whether alone or with radiotherapy. The relative risk for solid cancers was much greater in patients who were younger at first treatment (trend P<0.001), whereas leukaemia risk was greatest for those first treated at ages 25-44. For solid cancers (P<0.001) but not leukaemia (P=0.05) there was a strong gradient of greater relative risks at younger attained ages. The relative risk of second cancers overall was 27.5 at ages under 25 and 2.0 at ages 55 and above. Leukaemia and solid cancer risks in patients treated with chlorambucil, vinblastine, procarbazine and prednisone (ChIVPP) were not significantly greater than those in patients treated with mustine, vincristine, procarbazine and prednisone (MOPP). Number of cycles of chemotherapy was significantly related to risk of leukaemia (P<0.001), and there was a trend in the same direction for solid cancers (P=0.07). The study adds to evidence that alkylating chemotherapy may increase the risk of solid cancers, and that ChIVPP does not provide a less carcinogenic alternative to MOPP chemotherapy. The very large relative risks found for solid cancers at young attained ages and in patients treated when young may have important implications as, in the long term, the majority of second malignancies after Hodgkin's disease are solid cancers. The risks of solid malignancies need clarification by larger collaborative epidemiological studies.

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Section: Discussionsupporting

confidence: 86%

Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Swerdlow

Barber²,

Horwich³

et al. 1997

Br J Cancer

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“…The increase in risk is of the order of 10-lOO-folds over the general population and 3-10-folds over radiotherapy patients. The cumulative 10-year risk of leukaemia among HD patients treated with chemotherapy estimated by the studies listed in Table 2 varies between 1 and 40%, the highest rates being reported among patients treated with more than 6 MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) cycles in a study from Denmark (22) and among patients treated with radiotherapy and 120mg or more nitrogen mustard in a study from France (19). For cancers other than HD, a fraction of patients have been treated by surgery alone, and the leukaemia risk among these patients appears to be no higher than would be expected on the basis of general population rates, which allows valid comparisons between subgroups of patients in the same cohort.…”

Section: Risk Of Secondary Leukaemiamentioning

confidence: 99%

“…Among HD patients, the highest incidence of leukaemia occurs among patients treated with nitrogen mustard ( 1 1, 19), and among those treated with a combination, including nitrogen mustard, such as MOPP, thc risk is related to the number of cycles of combination therapy (Table 2) (21). It is interesting to note that no case of secondary leukaemia has been reported among 180 H D patients treated with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) combination only, and that in the IARC study on HD patients no case of leukaemia was observed among patients who underwent the same regimen (21).…”

Section: Risk Of Secondary Leukaemiamentioning

confidence: 99%

“…Early studies suggested that H D patients treated with both types of therapy are at increased risk o f leukaemia as compared to patients treated with chemotherapy only (Table 2 and (37, 38)). However, results from more recent studies have suggested that, after accounting for total chemotherapy dose, radiation does not affect the risk of secondary leukaemia (9, [18][19][20], and the IARC study on HD patients found a higher risk of leukaemia among patients at intermediate radiation doses (10-20 Gy to the active bone marrow) than among those at higher or lower doses (21).…”

Section: Risk Of Secondary Leukaemiamentioning

confidence: 99%

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Secondary Malignancies Following Cancer Chemotherapy

1994

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“…Die Ergebnisse der Studie HD-87 mit Wahrscheinlichkeiten für EFÜ von 85% und Überleben von 97% nach 7 Jahren in der Gesamtgruppe entsprechen anderen pädiatrischen Therapiestudien bei Morbus Hodgkin (1, 12,14,27 Sekundäre Leukämien oder Präleukämien werden vorwiegend der Chemotherapie zugeschrieben (11, 13,19…”

Section: Diskussionunclassified

Reduzierung der Strahlendosen auf 20-30 Gy im Rahmen einer kombinierten Chemo-/Radiotherapie beim Morbus Hodgkin im Kindesalter

Schellong

Hörnig-Franz²,

Rath³

et al. 1994

Klin Padiatr

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From Dec. 1986 to Sept. 1990, 204 pts from 51 centres were enrolled in the study. 196 were evaluable. 109 pts (55.6%) were laparotomized, 58 (29.6%) splenectomized. The accuracy for the prediction of an abdominal involvement was 72.3% in case of abnormal findings in abdominal CT/ultrasound but only 36.4% in case of enlarged lymph nodes at the pulmonary hilus without abdominal abnormalities. 91.2% of the removed spleens were proven involved. -2 out of 196 pts suffered progression under treatment, and 22 relapsed (as of 1 Jan, 1994). 6 pts died, 4 of whom succumbed to Hodgkin's disease, and 2 to intercurrent infections. 2 pts in first remission developed a secondary malignancy, namely 1 malignant histiocytoma in radiation field and 1 ANLL. Another patient developed a thyroid carcinoma following salvage therapy for a relapse. The probabilities of event-free survival (EFS) and survival after 7 years are for the total group: 85% and 97%, in group 1: 84% and 99%, in group 2: 82% and 93%, and group 3: 89% and 95%. Comparison with the precursor studies HD-82 and HD-85 reveals that the dose reduction in radiotherapy has not affected the results. Differences in EFS are exclusively correlated with changes in chemotherapy.

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Risk of Secondary Acute Leukemia and Preleukemia After Hodgkin’s Disease: The Institut Gustave-Roussy Experience

Cited by 26 publications

References 28 publications

Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Secondary Malignancies Following Cancer Chemotherapy

Reduzierung der Strahlendosen auf 20-30 Gy im Rahmen einer kombinierten Chemo-/Radiotherapie beim Morbus Hodgkin im Kindesalter

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