SECONDARY MALIGNANCIES IN A CHILD WITH HODGKINS-DISEASE - PERIPHERAL T-CELL LYMPHOMA AND MYELODYSPLASTIC SYNDROME EVOLVING INTO ACUTE NONLYMPHOBLASTIC LEUKEMIA

Hodgkin's disease (HD) has been linked to an increased risk of second malignant neoplasms (SMN), especially non-Hodgkin's lymphoma (NHL) and acute nonlymphoblastic leukaemia (ANLL). The mutagenic property of cy totoxic therapy as well as defective immunity have been implicated as playing a major role in the development of SMN in patients previously treated for HD. We report a case of a 14-year-old girl with HD who dev eloped two different second malignancies within a latent period of 28 months following HD diagnosis. The patient presented initially with bi lateral cervical and supraclavicular as well as mediastinal and paraao rtic lymphadenopathy. She was staged as IIIA, nodular sclerosing type HD, and was given eight alternative cycles of MOPP-ABVD followed by '' mantle'' field radiotherapy to a total dose of 3.3 Gy plus 0.4 Gy to t he upper mediastinum. Within 8 months following the completion of ther apy, a period of myelodysplasia and progressive severe immune deficien cy, considered as a result of initial treatment, occurred. Eighteen mo nths after HD diagnosis while the patient was continuously neutropenic and heavily immunocompromised, a peripheral T-cell lymphoma of the an giocentric immunoproliferative lesion type (AIL) Grade III, appeared i n both lungs within and beyond the radiation field, with no evidence o f HD in biopsy specimens. After institution of a new chemotherapy regi men (L17M), a satisfactory response regarding NHL lesions was noted. H owever, 10 months later the myelodysplastic syndrome (MDS) accompanied by complex chromosomal abnormalities evoluted to frank ANLL with a ra pid fatal course. This case supports the hypothesis that combined moda lity treatment accompanied by severe immunodeficiency may result in th e development of multiple second malignancies even within a very short latent period, especially in a subgroup of HD patients who may be at particularly increased risk for second cancers. (C) 1996 Wiley-Liss, I nc.