Second malignancies after childhood Hodgkin's disease: The memorial sloan-kettering cancer center experience

Abstract

A review of the Memorial Sloan-Kettering Cancer Center experience with second malignancies (SM) after childhood Hodgkin's Disease (HD) identified 17 SM in 320 patients who survived more than 1 year from, and were 15 years old or younger at the time of, HD diagnosis (1949 to 1983). Of 254 previously untreated patients, 12 SM were noticed as compared with 0.606 expected on the basis of rates in the general pediatric population (relative risk, 19.8; 95% confidence interval, 10.2 to 34.6). For patients who received multi-agent chemotherapy, the cumulative probability of developing acute nonlymphocytic leukemia (ANLL) or bone sarcoma was 6.2% and 5.5%, respectively, at 10 years from the initiation of therapy; the cumulative risk of all SM in this group reached 18.7% at 15 years. For patients who received radiation alone or with single-agent chemotherapy, the cumulative risk of SM rose from 0% at 10 years and 2% at 15 years, to 10.7% at 25 years from the initiation of treatment. The risk of ANLL after childhood HD was highest in the first 5 to 10 years after combined modality treatment, and aggressive forms of NHL were associated with excessive immunosuppression. Bone sarcomas predominated in solid SM in the first decade after HD treatment, whereas "adult-type" cancers, for example, breast and colon carcinomas, were more delayed. Our findings, supported by a literature review, point to a therapy-related enhanced risk of approximately age-appropriate solid SM. This possibility mandates careful surveillance of long-term survivors of childhood HD.

Secondary malignancies in pediatric cancer survivors: Perspectives and review of the literature

“…Previous HL protocols incorporated mechlorethamine as part of a four drug regimen (MOPP). Several groups subsequently reported a notable increase in t‐AML in HL patients treated with MOPP therapy . Swerdlow et al .…”

“…Several groups subsequently reported a notable increase in t-AML in HL patients treated with MOPP therapy. 7,12 Swerdlow et al reported on 5,798 patients with HL treated in Britain from 1963 to 2001 with MOPP and in later years, ABVD. There was an overall increased RR of a SMN of 2.0 (95% confidence interval [CI], 1.7-2.4) and 3.9 (95% CI, 3.5-4.4) in the patients treated with chemotherapy or chemotherapy 1 radiation, respectively.…”

Acute leukemia as a secondary malignancy in children and adolescents: Current findings and issues

“…(13–15) The Late Effects Study Group (LESG) observed that survivors of Hodgkin lymphoma who had been treated with alkylating agents at age 16 years or younger had a relative risk of leukemia almost 80 times that of population controls (standardized incidence ratio [SIR], 78.8; 95% CI, 56.6–123.2). The relative risk of s-AML in this group was 321.3 (95% CI, 207.5–467.1).…”

Bilateral Sertoli cell tumours presenting as a third primary malignancy

“…While a second neoplasm after treatment of childhood malignancy is a well recognised occurrence, studies showing a 1±17´6% cumulative risk (Boivin et al, 1984 ;Kusher et al, 1988 ;T ucker et al, 1988;Sont et al, 1992) the developm ent of two or more subsequent tumours is rare (Brody et al, 1977).…”